Ovarian torsion

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

all patients

1st line – surgical detorsion or salpingo-oophorectomy

Back

1st line –

surgical detorsion or salpingo-oophorectomy

Ensure the patient goes to surgery without delay where there is suspicion of ovarian torsion based on clinical signs and symptoms and/or findings on imaging, and where preserving fertility is a priority.

A delay in the timing of surgery is associated with a reduction in the possibility of ovarian salvage.[15]

Choice of surgical approach for detorsion, via laparoscopy versus laparotomy, depends on the clinical situation and clinical judgement.[27][58][60][70][71][72][73][74][75] If clinically appropriate, laparoscopy may be superior to laparotomy because it decreases hospital stay and postoperative pain, with reduced consumption of analgesic drugs.[56]

Intraoperative evaluation should be performed. Conservative management with detorsion is highly recommended regardless of the actual appearance of the ovary, which may be dusky, blue-black, or necrotic-appearing.[1][51][52][53][54] This ensures preservation of ovarian function in most cases.

Salpingo-oophorectomy may be performed if the ovary is thought to be non-viable, if malignancy is suspected, or if the patient is post-menopausal. However, the frequency of malignant tumours is extremely low.[31]

Involvement of the fallopian tube in the torsion of the adnexa may significantly damage the tube, which may occasionally need to be surgically removed (salpingectomy).

Guidelines on adnexal torsion in adolescents recommend that surgeons should not remove a torsed ovary unless oophorectomy is unavoidable (e.g., when a severely necrotic ovary falls apart).[1]

Consider – ovarian cystectomy

Consider – oophoropexy

Back

Consider –

oophoropexy

Additional treatment recommended for SOME patients in selected patient group

As torsion of normal ovaries is more common in children, oophoropexy (a procedure to fix the ovary in position to limit its range of movement), either unilateral or bilateral, may be helpful at the time of surgery to prevent recurrence.[63][65][66][67] However, the benefit of oophoropexy remains uncertain.[25][68][69] One systematic review did not find clear evidence to support oophoropexy after a first episode of ovarian torsion.[52] Oophoropexy remains controversial; its use is not generally recommended as a means to decrease the risk of recurrent ovarian torsion.[1]

Oophoropexy may be considered in specific settings; for example, absent contralateral ovary, elongated ovarian ligament, and torsion of normal adnexa.[62]

Use of this content is subject to our disclaimer

Ovarian torsion

Treatment algorithm

all patients

surgical detorsion or salpingo-oophorectomy

ovarian cystectomy

oophoropexy