# Adnexal Torsion — GCMD Library living collection

Everything in the library about adnexal torsion — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 40 cited statements

## Episodes
### Case-Based Learning
- [GYN #2 Oophoropexy in Adnexal Torsion with Dr. Lesley Breech](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571) — video · [machine version](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571.md)
- [GYN #3 Management of an Adnexal Torsion with a Healthy Appearing Ovary with Dr. Lesley Breech](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632) — video · [machine version](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632.md)
- [GYN #4 Management of Tubal Torsion: When to Consider Salpingectomy with Dr. Lesley Breech](https://library.globalcastmd.com/watch/gyn-4-management-of-tubal-torsion-when-to-consider-salpingectomy-with-dr-lesley-breech-9267) — video · [machine version](https://library.globalcastmd.com/watch/gyn-4-management-of-tubal-torsion-when-to-consider-salpingectomy-with-dr-lesley-breech-9267.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=0) Case presentation: Five-year-old with ovarian torsion (Ep 1)
- [0:43](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=43) Initial management: Detorsion and anatomic considerations in prepubertal patients (Ep 1)
- [3:00](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=180) Oophoropexy recommendations and recurrence rates (Ep 1)
- [5:00](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=300) Fertility considerations and oophoropexy failure rates (Ep 1)
- [7:00](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=420) Oophoropexy techniques and timing as interval procedure (Ep 1)
- [9:00](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=540) Postoperative management and activity restrictions (Ep 1)
- [11:00](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=660) Follow-up imaging and cystectomy timing (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=0) Case presentation: 10-year-old with adnexal torsion (Ep 2)
- [1:12](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=72) Principles of preserving reproductive structures (Ep 2)
- [2:54](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=174) Oophoropexy and recurrent torsion management (Ep 2)
- [4:01](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=241) Pre-operative workup and tumor markers (Ep 2)
- [5:13](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=313) Summary and key takeaways (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/gyn-4-management-of-tubal-torsion-when-to-consider-salpingectomy-with-dr-lesley-breech-9267?t=0) Case presentation: 12-year-old with adnexal torsion (Ep 3)
- [0:46](https://library.globalcastmd.com/watch/gyn-4-management-of-tubal-torsion-when-to-consider-salpingectomy-with-dr-lesley-breech-9267?t=46) Surgical anatomy, diagnosis of Wolffian duct remnant, and complete cyst resection technique (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "When managing ovarian torsion, the goal is to never take an ovary out" — Lesley Breech (clinical) [Ep 2 · 1:12](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=72)
- "A severely damaged fallopian tube can develop into a hydrosalpinx, which negatively impacts IVF success and leads to ectopic pregnancies" — Lesley Breech (clinical) [Ep 2 · 1:12](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=72)
- "After detorsion, if a fallopian tube looks severely damaged, it should be photographed and documented to inform long-term care providers about its condition" — Lesley Breech (clinical) [Ep 2 · 1:50](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=110)
- "Dr. Breech's goal is to retain reproductive structures, but fallopian tubes are not as durable, strong, or resilient as ovaries" — Em Gootee (host_summary) [Ep 2 · 2:20](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=140)
- "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" — Lesley Breech (clinical) [Ep 2 · 2:30](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=150)
- "When resecting structures, complete resection is important because Wolffian duct remnants will recur if not fully removed" — Em Gootee (host_summary) [Ep 2 · 2:54](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=174)
- "Oophoropexy should not be performed at the time of detorsion but should be considered as an interval procedure" — Em Gootee (host_summary) [Ep 2 · 3:10](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=190)
- "In gynecology, recurrent torsion is defined as occurring more than once" — Lesley Breech (clinical) [Ep 2 · 3:20](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=200)
- "After puberty, birth control pills can be prescribed to suppress the ovary, keep ovaries small, minimize cysts, and decrease the risk of recurrent torsion" — Em Gootee (host_summary) [Ep 2 · 3:41](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=221)
- "Before puberty (in 8-10 year olds), hormonal suppression is not an option and oophoropexy is the only intervention for recurrent torsion" — Em Gootee (host_summary) [Ep 2 · 3:41](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=221)
- "There are no specific blood tests that should be sent prior to surgery for suspected torsion" — Em Gootee (host_summary) [Ep 2 · 4:26](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=266)
- "Tumor markers like CA-125 are non-specific and will likely be elevated in torsion cases, causing confusion about management strategies" — Em Gootee (host_summary) [Ep 2 · 4:26](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=266)
- "Elevated CA-125 in torsion is due to the inflammation process, not tumor presence" — Lesley Breech (clinical) [Ep 2 · 4:49](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=289)
- "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" — Lesley Breech (clinical) [Ep 2 · 4:49](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=289)
- "From a gynecologic standpoint, the approach should be to wait, reassess, and perform an interval ovarian cystectomy if needed to preserve fertility" — Em Gootee (host_summary) [Ep 2 · 5:13](https://library.globalcastmd.com/watch/gyn-3-management-of-an-adnexal-torsion-with-a-healthy-appearing-ovary-with-dr-lesley-breech-8632?t=313)
- "In many cases of adnexal torsion, the finding is a big edematous fallopian tube rather than an actual cyst." — Lesley Breech (clinical) [Ep 1 · 0:43](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=43)
- "In a five year old, you wouldn't really find a paraovarian or wolfian duct cyst, as those present really after puberty." — Lesley Breech (clinical) [Ep 1 · 1:00](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=60)
- "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." — Lesley Breech (clinical) [Ep 1 · 1:25](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=85)
- "In a teenager, there is space, and you could leave a large edematous ovary in the pelvis to let the edema come down." — Lesley Breech (clinical) [Ep 1 · 1:45](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=105)
- "There is no definitive time frame for ovarian torsion, unlike testes that only have a very short lifespan." — Lesley Breech (clinical) [Ep 1 · 2:10](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=130)
- "The ovary is more resilient than testes and it rebounds." — Lesley Breech (clinical) [Ep 1 · 2:25](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=145)
- "Oophoropexy is not recommended at the time of detorsion in prepubertal girls." — Lesley Breech (guideline) [Ep 1 · 2:45](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=165)
- "Recurrent torsion constitutes about 10 to 15% of all cases of torsion in the pediatric population." — Lesley Breech (epidemiological) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=180)
- "Torsion is more common on the right side because there's no sigmoid colon to protect it from twisting." — Lesley Breech (clinical) [Ep 1 · 3:15](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=195)
- "The American College of Obstetricians and Gynecologists does not recommend doing oophoropexy for every patient who has a torsion in teenagers." — Lesley Breech (guideline) [Ep 1 · 3:30](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=210)
- "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." — Lesley Breech (clinical) [Ep 1 · 3:50](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=230)
- "If doing an oophoropexy and placing the ovary in a safe place, you might unfortunately interrupt good communication with the fallopian tube and ovary." — Lesley Breech (clinical) [Ep 1 · 4:15](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=255)
- "Providers could iatrogenically introduce some degree of impairment in fertility if not oophoropexying in the right site." — Lesley Breech (clinical) [Ep 1 · 4:35](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=275)
- "About 30% of oophoropexies end up failing." — Lesley Breech (epidemiological) [Ep 1 · 5:00](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=300)
- "Utero-ovarian ligament shortening is one of the oophoropexy approaches that fails more commonly than other approaches." — Lesley Breech (clinical) [Ep 1 · 5:10](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=310)
- "At the time of actual torsion, the ovaries can look horrible, very edematous and hemorrhagic in nature." — Lesley Breech (clinical) [Ep 1 · 6:00](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=360)
- "After a torsion, it's not the time to do the oophoropexy; it's an interval procedure when you have fabulous looking ovaries because the ovary has healed well." — Lesley Breech (clinical) [Ep 1 · 6:20](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=380)
- "Gynecologists use a three-point fixation for stabilization: the uterosacral ligament, the pelvic sidewall, and shortening the uteroovarian ligament." — Lesley Breech (clinical) [Ep 1 · 6:45](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=405)
- "In prepubertal girls, it can take much longer for edema to regress and come down." — Lesley Breech (clinical) [Ep 1 · 8:00](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=480)
- "We often don't re-image for as long as about two to three months so that edema is completely resolved." — Lesley Breech (clinical) [Ep 1 · 8:15](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=495)
- "Follow-up ultrasound should always be done after detorsion." — Lesley Breech (guideline) [Ep 1 · 8:40](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=520)
- "About 46% of patients won't have any real persistent mass or lesion in the ovary after detorsion." — Lesley Breech (epidemiological) [Ep 1 · 8:50](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=530)
- "Some patients may have a longer utero ovarian ligament or longer infundibulopelvic ligament as anatomic differences that predispose them to torsion." — Lesley Breech (clinical) [Ep 1 · 9:05](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=545)
- "Literature suggests that if you have a very hemorrhagic edematous ovary, you can damage the ovary more by doing cystectomy then, than waiting to do it later." — Lesley Breech (clinical) [Ep 1 · 9:25](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=565)
- "When intervening acutely during the time of a torsion, we can damage the ovary, and the goal is for follicular survival to preserve future fertility." — Lesley Breech (clinical) [Ep 1 · 9:50](https://library.globalcastmd.com/watch/gyn-2-oophoropexy-in-adnexal-torsion-with-dr-lesley-breech-8571?t=590)
- "The cystic structure in this case is a paratubular or Wolffian duct remnant." — Leslie Breach (clinical) [Ep 3 · 0:46](https://library.globalcastmd.com/watch/gyn-4-management-of-tubal-torsion-when-to-consider-salpingectomy-with-dr-lesley-breech-9267?t=46)
- "Paratubular or Wolffian duct remnant cysts create risk for twisting and typically happen at puberty." — Leslie Breach (clinical) [Ep 3 · 0:46](https://library.globalcastmd.com/watch/gyn-4-management-of-tubal-torsion-when-to-consider-salpingectomy-with-dr-lesley-breech-9267?t=46)
- "It is really important to ensure complete resection of the entire cyst wall." — Leslie Breach (clinical) [Ep 3 · 0:46](https://library.globalcastmd.com/watch/gyn-4-management-of-tubal-torsion-when-to-consider-salpingectomy-with-dr-lesley-breech-9267?t=46)
- "The fallopian tube is typically seen stretched across the cyst." — Leslie Breach (clinical) [Ep 3 · 0:46](https://library.globalcastmd.com/watch/gyn-4-management-of-tubal-torsion-when-to-consider-salpingectomy-with-dr-lesley-breech-9267?t=46)
- "When doing this kind of resection, it is really important to trace the path of the fallopian tube." — Leslie Breach (clinical) [Ep 3 · 0:46](https://library.globalcastmd.com/watch/gyn-4-management-of-tubal-torsion-when-to-consider-salpingectomy-with-dr-lesley-breech-9267?t=46)
- "It is not a problem to get into the mesosalpinx during resection, but protection of the fallopian tube path is critical." — Leslie Breach (clinical) [Ep 3 · 0:46](https://library.globalcastmd.com/watch/gyn-4-management-of-tubal-torsion-when-to-consider-salpingectomy-with-dr-lesley-breech-9267?t=46)
- "Incomplete resection of the cyst will result in recurrence." — Leslie Breach (clinical) [Ep 3 · 0:46](https://library.globalcastmd.com/watch/gyn-4-management-of-tubal-torsion-when-to-consider-salpingectomy-with-dr-lesley-breech-9267?t=46)
- "In managing adnexal torsion with a Wolffian duct remnant, the key steps are: accurately diagnose, promptly untwist the adnexa, carefully resect the cyst wall, and ensure the fallopian tube's integrity." — Leslie Breach (clinical) [Ep 3 · 0:46](https://library.globalcastmd.com/watch/gyn-4-management-of-tubal-torsion-when-to-consider-salpingectomy-with-dr-lesley-breech-9267?t=46)

## Changelog
- Sep 25: 3 items added automatically

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