Ovarian (Adnexal) Torsion Treatment & Management

Updated: Sep 29, 2022
  • Author: Erik D Schraga, MD; Chief Editor: Eugene C Lin, MD  more...
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Approach Considerations

In a patient with a history and physical examination findings suggestive of ovarian torsion, gynecologic consultation and subsequent laparoscopy are critical, regardless of whether laboratory and radiologic studies yield normal results.

Approximately 1 in 1800 pregnancies are complicated by adnexal torsion, typically between the sixth and fourteenth weeks of gestation. This increased frequency in pregnant women is likely due to greater laxity of the tissues adjoining the ovaries and oviducts during pregnancy, as well as to enlargement of the ovary in early pregnancy secondary to the corpus luteum cyst.

Detorsion of the adnexa during pregnancy has not been found to compromise fetal well-being. However, if the corpus luteum cyst is removed during salpingo-oophorectomy, supplemental progesterone is indicated. Management of ovarian torsion is dependent on various factors. Oophorectomy can have significant implications for fertility and general health, thus requiring careful consideration. [44]

Patients with either a suspected or confirmed diagnosis of ovarian torsion should be admitted and either operated on or observed by a gynecologist. Laparoscopy can be used for both confirmation of the diagnosis and treatment. A retrospective analysis revealed that single-incision laparoscopic surgery appears to be as feasible, effective, and safe as conventional laparoscopy for treatment of patients with ovarian torsion. [45]

Ovarian torsion is a gynecologic emergency that may lead to ovarian necrosis, infection, and peritonitis. Early recognition is essential in preserving the ovary, particularly for patients with future fertility aspirations. Currently, no consensus has been reached regarding the time period of ovarian viability after onset of symptoms. Awareness of this condition among community members and healthcare professionals is crucial. Routine investigations should not delay management, as positive Doppler flow on ultrasonography does not exclude a diagnosis of ovarian torsion. [46]