Update Course Rewind: Ovarian Torsion Management 2023

Apparent cystic areas on ultrasound in ovarian torsion cases are often actually edema of the fallopian tube rather than true cysts.

Oophorectomy should not be performed in ovarian torsion cases.

There is no good data showing a timeline or appearance that would indicate an ovary will not survive after torsion.

The standard approach is to always detorse the ovary and leave it in place.

In a recent quality improvement project, some institutions performed oophorectomy in as many as 25% of ovarian torsion cases.

For a black, edematous fallopian tube in a prepubertal girl, there is plenty of time to figure out management.

In adolescent patients with edematous fallopian tubes, future tubal function is a concern because the tube must be patent and have open fimbria to function properly.

Scarring of the fallopian tube is a concern for future fertility and increases risk for ectopic pregnancies.

Some surgeons perform oophoropexy in cases where there is nothing clearly causing the torsion, as a strategy to prevent recurrence.

A good percentage of patients with ovarian torsion will have nothing wrong with the ovary itself.

Some surgeons incise the ovarian cortex to release edema and reduce swelling in edematous ovaries.

With significant edema, it is difficult to determine intraoperatively if there is underlying pathology in the ovary that needs to be removed.

Most gynecologists untwist the ovary, leave it in place, and obtain follow-up imaging to identify any underlying ovarian pathology that might have caused the torsion.

Paratubal or paraovarian cysts increase the risk of torsion and should be removed rather than aspirated to prevent recurrence.

The highest risk of torsion in an edematous ovary is in prepubertal girls.

In pubertal females, the posterior cul-de-sac has sufficient room to accommodate a 4-5 centimeter ovary with a cyst, which occurs monthly with ovulation.

A paper suggested the risk of re-torsion could be anywhere between 10 to 15%, but it does not stratify immediate recurrence versus patients already at risk for re-torsion.

Patients who have already had torsion three, four, or five times, or who are gymnasts, or who have long ligaments, have predisposing factors for recurrent torsion.

There is a risk of re-torsion in an edematous ovary, but time should be given for the edema to resolve while attempting to preserve the ovary.