Grand Rounds
Adnexal Torsion
Everything in the library about adnexal torsion — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Case-Based Learning
3 items
GYN #2 Oophoropexy in Adnexal Torsion with Dr. Lesley Breech
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In this video, we have a guest from the pediatric gynecology department here at Cincinnati Children’s, Dr. Lesley Breech. And she will talk about oophoropexy in adnexal torsion. Host: Em Gootee
Resources:
ACOG Committee Opinion, Numbe
video · May 2024
GYN #3 Management of an Adnexal Torsion with a Healthy Appearing Ovary with Dr. Lesley Breech
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In this episode, we have a guest from the pediatric gynecology department here at Cincinnati Children’s, Dr. Lesley Breech. And she will talk about management of an adnexal torsion with a healthy appearing ovary.
Host: Em Gootee
video · May 2024
GYN #4 Management of Tubal Torsion: When to Consider Salpingectomy with Dr. Lesley Breech
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In this episode, we have a guest from the pediatric gynecology department here at Cincinnati Children’s, Dr. Lesley Breech. And she will talk about management of tubal torsion and when to consider salpingectomy.
Host: Em Gootee
video · Oct 2024
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
GYN #3 Management of an Adnexal Torsion with a Healthy Appearing Ovary with Dr. Lesley Breech
When managing ovarian torsion, the goal is to never take an ovary out
clinicalLesley Breech1:12 ↗
A severely damaged fallopian tube can develop into a hydrosalpinx, which negatively impacts IVF success and leads to ectopic pregnancies
clinicalLesley Breech1:12 ↗
After detorsion, if a fallopian tube looks severely damaged, it should be photographed and documented to inform long-term care providers about its condition
clinicalLesley Breech1:50 ↗
Dr. Breech's goal is to retain reproductive structures, but fallopian tubes are not as durable, strong, or resilient as ovaries
host_summaryEm Gootee2:20 ↗
When a fallopian tube has had significant trauma without improvement in health, removal of the tube should be considered to decrease further reproductive risk associated with a poorly functional tube
clinicalLesley Breech2:30 ↗
When resecting structures, complete resection is important because Wolffian duct remnants will recur if not fully removed
host_summaryEm Gootee2:54 ↗
Oophoropexy should not be performed at the time of detorsion but should be considered as an interval procedure
host_summaryEm Gootee3:10 ↗
In gynecology, recurrent torsion is defined as occurring more than once
clinicalLesley Breech3:20 ↗
After puberty, birth control pills can be prescribed to suppress the ovary, keep ovaries small, minimize cysts, and decrease the risk of recurrent torsion
host_summaryEm Gootee3:41 ↗
Before puberty (in 8-10 year olds), hormonal suppression is not an option and oophoropexy is the only intervention for recurrent torsion
host_summaryEm Gootee3:41 ↗
There are no specific blood tests that should be sent prior to surgery for suspected torsion
host_summaryEm Gootee4:26 ↗
Tumor markers like CA-125 are non-specific and will likely be elevated in torsion cases, causing confusion about management strategies
host_summaryEm Gootee4:26 ↗
Elevated CA-125 in torsion is due to the inflammation process, not tumor presence
clinicalLesley Breech4:49 ↗
For suspected torsion, the patient should be taken to the OR, the structure detorsed, and management decisions made based on intraoperative findings, with follow-up later
clinicalLesley Breech4:49 ↗
From a gynecologic standpoint, the approach should be to wait, reassess, and perform an interval ovarian cystectomy if needed to preserve fertility
host_summaryEm Gootee5:13 ↗
GYN #2 Oophoropexy in Adnexal Torsion with Dr. Lesley Breech
In many cases of adnexal torsion, the finding is a big edematous fallopian tube rather than an actual cyst.
clinicalLesley Breech0:43 ↗
In a five year old, you wouldn't really find a paraovarian or wolfian duct cyst, as those present really after puberty.
clinicalLesley Breech1:00 ↗
In little girls after untwisting, there is a large edematous ovary and it's really hard to find any place to put it, and it could retorse right away.
clinicalLesley Breech1:25 ↗
In a teenager, there is space, and you could leave a large edematous ovary in the pelvis to let the edema come down.
clinicalLesley Breech1:45 ↗
There is no definitive time frame for ovarian torsion, unlike testes that only have a very short lifespan.
clinicalLesley Breech2:10 ↗
The ovary is more resilient than testes and it rebounds.
clinicalLesley Breech2:25 ↗
Oophoropexy is not recommended at the time of detorsion in prepubertal girls.
guidelineLesley Breech2:45 ↗
Recurrent torsion constitutes about 10 to 15% of all cases of torsion in the pediatric population.
epidemiologicalLesley Breech3:00 ↗
Torsion is more common on the right side because there's no sigmoid colon to protect it from twisting.
clinicalLesley Breech3:15 ↗
The American College of Obstetricians and Gynecologists does not recommend doing oophoropexy for every patient who has a torsion in teenagers.
guidelineLesley Breech3:30 ↗
Good communication between the fallopian tube and ovary is important so that when ovulation is happening, the tube gets the eggs and brings it down to meet the sperm.
clinicalLesley Breech3:50 ↗
If doing an oophoropexy and placing the ovary in a safe place, you might unfortunately interrupt good communication with the fallopian tube and ovary.
clinicalLesley Breech4:15 ↗
Providers could iatrogenically introduce some degree of impairment in fertility if not oophoropexying in the right site.
clinicalLesley Breech4:35 ↗
About 30% of oophoropexies end up failing.
epidemiologicalLesley Breech5:00 ↗
Utero-ovarian ligament shortening is one of the oophoropexy approaches that fails more commonly than other approaches.
clinicalLesley Breech5:10 ↗
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