From the Guidelines
Ovarian torsion requires immediate surgical intervention with laparoscopy or laparotomy to prevent tissue necrosis and preserve ovarian function, as evidenced by the most recent guidelines from the Journal of the American College of Radiology 1. The management of ovarian torsion involves a multidisciplinary approach, including prompt diagnosis, surgical intervention, and post-operative care.
- Diagnosis is typically made using pelvic ultrasound with Doppler flow studies, which has a sensitivity of 80% and specificity of 88% in diagnosing adnexal torsion 1.
- Surgical intervention should be performed as soon as possible, with the goal of untwisting the affected ovary and restoring blood flow to prevent tissue necrosis.
- During surgery, the surgeon should assess ovarian viability after detorsion, and even black-bluish appearing ovaries should be untwisted and preserved, as they often recover with restored blood flow 1.
- Oophorectomy should only be performed if there is clear necrosis or if the patient is perimenopausal or postmenopausal, and ovarian conservation is preferred whenever possible, especially in women of reproductive age.
- Post-operative care includes standard pain management with opioid analgesics, early ambulation, and follow-up ultrasound in 6-8 weeks to confirm ovarian recovery.
- To prevent recurrence, oophoropexy (fixation of the ovary to the pelvic sidewall, uterus, or round ligament) may be considered, especially in cases of recurrent torsion or if the contralateral ovary has previously been removed 1. The importance of prompt intervention cannot be overstated, as the window for tissue salvage is approximately 8-10 hours after symptom onset, though viable tissue has been found even after 24-36 hours in some cases 1.
From the Research
Management of Ovarian Torsion
The management of ovarian torsion typically involves surgical intervention, with the goal of preserving ovarian viability and function. The following are key points to consider:
- Surgical management is the mainstay of treatment for ovarian torsion, with laparoscopic detorsion being a commonly used approach 2, 3, 4, 5.
- Ovarian preservation is preferred in almost all cases, especially in young women who wish to preserve their fertility 2, 3, 5.
- Detorsion of the torquated ovary, followed by cystectomy or oophoropexy, may be performed to prevent recurrence and preserve ovarian function 2, 5.
- Postoperative management typically involves monitoring for relief of pain and normalization of ovarian size and morphology on ultrasound imaging 2.
- Early diagnosis and treatment are crucial to preserve ovarian viability, even if necrosis is seen operatively 3.
Surgical Techniques
Various surgical techniques may be used to manage ovarian torsion, including:
- Laparoscopic detorsion, which involves untwisting the ovary and restoring blood flow 2, 4, 5.
- Cystectomy, which involves removing the ovarian cyst or mass that caused the torsion 2, 5.
- Oophoropexy, which involves attaching the ovary to the pelvic side wall or utero-ovarian ligament to prevent recurrence 2.
Importance of Early Diagnosis
Early diagnosis and treatment of ovarian torsion are critical to prevent severe morbidity and preserve ovarian function. Delayed diagnosis can lead to increased risk of ovarian necrosis and loss of fertility 3, 6.