# Ovarian Torsion — GCMD Library living collection

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

Updated: n/a · 3 episodes · 104 cited statements

## Episodes
### Case-Based Learning
- [Ovarian Salvage (Torsion & Benign Tumor): Practice Gap discussion at Update...](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344) — video · 14:07 · [machine version](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344.md)

### In-Depth Reviews
- [Ovarian Torsion with Dr. Jennifer Dietrich](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949) — podcast · 47:22 · [machine version](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949.md)
- [Ovarian Torsion with Dr. Jennifer Dietrich](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306) — podcast · 47:22 · [machine version](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=0) Introduction and Initial Evaluation of Lower Abdominal Pain (Ep 3)
- [3:23](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=203) Ultrasound Interpretation and Blood Flow Assessment (Ep 3)
- [7:04](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=424) Imaging Findings and Risk Factors for Torsion (Ep 3)
- [11:12](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=672) Malignancy Evaluation and Advanced Imaging (Ep 3)
- [15:00](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=900) Clinical Diagnosis and Timing of Intervention (Ep 3)
- [19:40](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1180) Differential Diagnosis: Hemorrhagic Cysts (Ep 3)
- [22:51](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1371) Surgical Management: Detorsion and Cystectomy (Ep 3)
- [27:51](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1671) Ovarian Bivalving and Debulking Procedures (Ep 3)
- [30:17](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1817) Oophoropexy Techniques and Indications (Ep 3)
- [34:50](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2090) Management of Tubal-Ovarian Abscess and Ectopic Pregnancy (Ep 3)
- [39:57](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2397) Endometriosis Recognition and Management (Ep 3)
- [42:22](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2542) Postoperative Management and Surveillance (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=0) Case presentation and ultrasound limitations in ovarian torsion (Ep 1)
- [3:00](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=180) Management of necrotic ovaries and the decision to preserve versus remove (Ep 1)
- [7:29](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=449) Managing ovarian masses in the setting of torsion (Ep 1)
- [12:12](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=732) Technical considerations and summary teaching points (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=0) Introduction and Case Presentation (Ep 2)
- [1:42](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=102) Initial Evaluation and Ultrasound Interpretation (Ep 2)
- [5:27](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=327) Diagnostic Criteria and Risk Factors (Ep 2)
- [9:23](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=563) Malignancy Evaluation and Advanced Imaging (Ep 2)
- [15:00](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=900) Timing of Surgical Intervention (Ep 2)
- [19:44](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1184) Classic Presentation and Differential Diagnosis (Ep 2)
- [22:36](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1356) Surgical Management: Detorsion and Cystectomy (Ep 2)
- [27:50](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1670) Ovarian Bivalving and Debulking (Ep 2)
- [30:17](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1817) Oophoropexy Techniques and Indications (Ep 2)
- [34:57](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2097) Tubo-Ovarian Abscess and Ectopic Pregnancy (Ep 2)
- [39:57](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2397) Endometriosis Recognition and Management (Ep 2)
- [42:22](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2542) Postoperative Care and Surveillance (Ep 2)
- [45:00](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2700) Closing Remarks (Ep 2)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "In all reproductive age females presenting with lower abdominal pain, a pregnancy test should be checked regardless of sexual history." — Jennifer Dietrich (guideline) [Ep 3 · 2:02](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=122)
- "Ultrasound provides real-time and still pictures with better penetration capabilities regardless of patient BMI, as long as the female has a full bladder." — Jennifer Dietrich (clinical) [Ep 3 · 2:57](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=177)
- "Significant asymmetry between ovaries on ultrasound, particularly enlargement on the side of pain, raises concern for adnexal torsion." — Jennifer Dietrich (clinical) [Ep 3 · 3:31](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=211)
- "Complete absence of blood flow on ultrasound is the most concerning and more reliable finding; presence of blood flow is actually less reliable in diagnosing torsion." — Jennifer Dietrich (clinical) [Ep 3 · 4:33](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=273)
- "Blood flow may be present in ovarian torsion because it could be just a torsed tube, in which case flow to the ovary would still be visible." — Jennifer Dietrich (clinical) [Ep 3 · 5:00](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=300)
- "Intermittent torsion can occur, and if diagnosis is difficult, observation with repeat ultrasound may help if the patient's condition declares itself." — Jennifer Dietrich (clinical) [Ep 3 · 6:14](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=374)
- "When the ovary is edematous with compromised blood supply, follicles become peripheralized to the ovary's periphery due to vascular congestion in the middle." — Jennifer Dietrich (clinical) [Ep 3 · 7:15](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=435)
- "In the literature, cysts around 5 or 6 centimeters in size increase concern for torsion risk in the setting of symptoms, as they make the ovary and tube heavy enough to twist." — Jennifer Dietrich (clinical) [Ep 3 · 8:50](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=530)
- "In prepubertal girls, normal ovaries can torse, and torsion is the most common reason these children undergo surgery for a gynecologic indication." — Jennifer Dietrich (epidemiological) [Ep 3 · 9:31](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=571)
- "There is no specific size cutoff for torsion risk; diagnosis is based on clinical presentation. Prepubertal ovaries are very small (1-1.5 cm), but normal ovaries can still twist." — Jennifer Dietrich (clinical) [Ep 3 · 10:19](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=619)
- "Complex features on ultrasound (partly cystic, partly solid) with hypervascular flow within the lesion and elevated tumor markers raise concern for malignancy." — Jennifer Dietrich (clinical) [Ep 3 · 11:24](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=684)
- "CT is beneficial to distinguish an adnexal lesion from an abscess or appendiceal pathology when infection is a concern." — Jennifer Dietrich (clinical) [Ep 3 · 12:17](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=737)
- "MRI is useful to distinguish torsion from Müllerian anomalies with outflow tract obstruction, where a hematosalpinx may mimic torsion on ultrasound." — Jennifer Dietrich (clinical) [Ep 3 · 12:36](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=756)
- "Pelvic exams in adolescents are typically delayed until later teenage years or until the first Pap smear at age 21, unless specific concerns arise." — Jennifer Dietrich (guideline) [Ep 3 · 13:19](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=799)
- "Tumor markers sent for complex adnexal masses include alpha-fetoprotein, serum beta-HCG quantitative, lactate dehydrogenase, and CA-125." — Jennifer Dietrich (clinical) [Ep 3 · 15:06](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=906)
- "At Texas Children's Hospital, three out of four tumor markers return within an hour to hour and a half, allowing results before OR posting." — Jennifer Dietrich (clinical) [Ep 3 · 15:57](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=957)
- "Studies from Boston Children's show that salvage rates are higher within the first 24 to 72 hours from onset of abdominal pain compared to one week." — Jennifer Dietrich (host_summary) [Ep 3 · 17:26](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1046)
- "It is unpredictable whether a patient has a loose torsion with more time or a tight torsion with rapid ischemia development, so diagnosis should be addressed as soon as possible." — Jennifer Dietrich (clinical) [Ep 3 · 17:52](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1072)
- "Ovarian torsion is a clinical diagnosis; if clinical suspicion is high, surgery should proceed regardless of ultrasound findings including blood flow." — Jennifer Dietrich (guideline) [Ep 3 · 18:16](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1096)
- "If the diagnosis is uncertain, observation for a few hours is reasonable to see if a patient with intermittent torsion declares herself, but the patient should not be sent home." — Jennifer Dietrich (clinical) [Ep 3 · 18:56](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1136)
- "A classic torsion presentation includes acute onset abdominal pain after physical activity (gymnastics, cartwheels), persistent pain unresponsive to over-the-counter measures, nausea and vomiting, and ultrasound showing ovarian asymmetry on the painful side." — Jennifer Dietrich (clinical) [Ep 3 · 19:52](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1192)
- "Hemorrhagic ovarian cysts are more likely in females who are already menstruating, and menstrual history (regularity, timing of last cycle) helps determine risk for hemorrhagic or corpus luteum cysts." — Jennifer Dietrich (clinical) [Ep 3 · 21:22](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1282)
- "Doppler can help differentiate hemorrhagic cysts from torsion: within a hemorrhagic cyst there is no flow, but peripheral to the cyst there is flow." — Jennifer Dietrich (clinical) [Ep 3 · 22:09](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1329)
- "At surgery for torsion, the ovary is detorsed and any lesion (peritubal or ovarian cyst) is removed, as the lesion's weight made the adnexa prone to twisting." — Jennifer Dietrich (clinical) [Ep 3 · 22:51](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1371)
- "Oophorectomy and salpingo-oophorectomy should be avoided at all times; even purple, black and blue ovaries can recover over time after detorsion." — Jennifer Dietrich (guideline) [Ep 3 · 23:35](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1415)
- "For non-ischemic torsion, cystectomy is performed rather than simple drainage unless the cyst is clearly functional." — Jennifer Dietrich (clinical) [Ep 3 · 23:49](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1429)
- "Peritubal cysts will recur if not completely excised; the technique involves opening the mesosalpinx beneath the fallopian tube and shelling out the cyst wall." — Jennifer Dietrich (clinical) [Ep 3 · 24:18](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1458)
- "For expanding hemorrhagic cysts, the cyst should be removed and bleeding areas coagulated; if the cyst wall is not completely removed, the cyst may continue to bleed." — Jennifer Dietrich (clinical) [Ep 3 · 25:04](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1504)
- "Even necrotic-appearing ovaries should be salvaged unless the tissue is literally falling apart during detorsion; ovarian function and follicles can return after a few months." — Jennifer Dietrich (clinical) [Ep 3 · 26:20](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1580)
- "Follow-up studies at Texas Children's Hospital show return of ovarian function and evidence of follicles in patients who had torsed ovaries preserved." — Jennifer Dietrich (clinical) [Ep 3 · 26:47](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1607)
- "Whether to remove the fallopian tube along with a necrotic ovary depends on whether the tube is involved in the torsion and completely devitalized or salvageable." — Jennifer Dietrich (clinical) [Ep 3 · 27:35](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1655)
- "The ovarian bivalving procedure, described at Boston Children's, involves making an incision into the ovarian cortex after detorsion to relieve compartment syndrome-like vascular congestion." — Jennifer Dietrich (host_summary) [Ep 3 · 27:56](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1676)
- "Bivalving may be needed when the ovary remains edematous after detorsion, to debulk the ovary and reduce re-torsion risk, especially when there is no lesion to remove." — Jennifer Dietrich (clinical) [Ep 3 · 28:48](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1728)
- "Energy devices such as harmonic scalpel or monopolar hook can be used for ovarian bivalving and debulking procedures." — Jennifer Dietrich (clinical) [Ep 3 · 29:43](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1783)
- "Oophoropexy is considered when a child has lost one ovary and presents with torsion of the remaining ovary, or in cases of recurrent torsion." — Jennifer Dietrich (clinical) [Ep 3 · 30:53](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1853)
- "Oophoropexy may change future fertility potential, but preserving the ovary is better than losing it; in vitro technologies remain an option for egg retrieval." — Jennifer Dietrich (opinion) [Ep 3 · 31:18](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1878)
- "Absorbable suture material can be used for oophoropexy to hold the adnexa still for 4-6 weeks while inflammation resolves, minimizing near-term re-torsion risk." — Jennifer Dietrich (clinical) [Ep 3 · 31:54](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1914)
- "Clipping the utero-ovarian ligament does not always prevent torsion because torsion can occur on either the utero-ovarian ligament or the infundibulopelvic ligament." — Jennifer Dietrich (clinical) [Ep 3 · 32:37](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1957)
- "Oophoropexy techniques include shortening the utero-ovarian ligament (by suturing it closer together), fixation to the pelvic sidewall (avoiding ureters), or fixation to the back of the uterus." — Jennifer Dietrich (clinical) [Ep 3 · 33:10](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1990)
- "For tubal-ovarian abscess, antibiotics should be started and the abscess should not be disturbed unless the patient is crashing, to avoid seeding other pelvic structures." — Jennifer Dietrich (clinical) [Ep 3 · 35:14](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2114)
- "Ectopic pregnancy can present similarly to torsion with acute pain and an adnexal mass, and may not be visible on transabdominal ultrasound if beta-HCG levels are below the threshold for visualization." — Jennifer Dietrich (clinical) [Ep 3 · 35:57](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2157)
- "For tubal ectopic pregnancy, a salpingostomy is made, the ectopic pregnancy is removed, hemostasis is ensured, and tissue is submitted for pathology; the tube is not sutured closed." — Jennifer Dietrich (clinical) [Ep 3 · 38:07](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2287)
- "Pelvic structures heal well without suturing; suturing can cause more scar tissue and stricture formation than leaving small incisions to heal on their own." — Jennifer Dietrich (clinical) [Ep 3 · 38:56](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2336)
- "Endometriosis in young adolescents presents with atypical lesions (clear or red) rather than the classic blue or black lesions seen in adults with advanced disease." — Jennifer Dietrich (clinical) [Ep 3 · 39:57](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2397)
- "To identify clear endometriosis lesions, fill the pelvis with crystalloid fluid and examine the cul-de-sac closely with the camera underwater to see blebs pulling away from the peritoneum." — Jennifer Dietrich (clinical) [Ep 3 · 40:55](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2455)
- "Endometriosis lesions can be excised with cold scissors when near the ureter or bowel, or ablated in other locations." — Jennifer Dietrich (clinical) [Ep 3 · 41:52](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2512)
- "Patients can go home within a few hours after laparoscopic surgery if they meet postoperative milestones, with activity limited for 4-6 weeks to allow incision healing and avoid hernia formation." — Jennifer Dietrich (clinical) [Ep 3 · 42:22](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2542)
- "Oral contraceptive pills can prevent recurrence if the torsion was caused by a functional cyst, but will not help with dermoid cysts or peritubal cysts." — Jennifer Dietrich (clinical) [Ep 3 · 43:31](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2611)
- "Surveillance ultrasound is obtained at 3 months post-surgery (allowing time for inflammation to resolve), then at 3-6 months if the ovary is still recovering, then annually." — Jennifer Dietrich (clinical) [Ep 3 · 44:32](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2672)
- "In all reproductive age females presenting with lower abdominal pain, a pregnancy test should be checked regardless of sexual activity history." — Jennifer Dietrich (guideline) [Ep 2 · 1:48](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=108)
- "Ultrasound provides adequate penetration for ovarian evaluation in both low and high BMI females when the patient has a full bladder." — Jennifer Dietrich (clinical) [Ep 2 · 2:57](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=177)
- "Significant asymmetry between ovaries on ultrasound, particularly enlargement on the symptomatic side, raises concern for adnexal torsion." — Jennifer Dietrich (clinical) [Ep 2 · 3:31](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=211)
- "Peripheralization of follicles to the ovarian periphery suggests vascular congestion from torsion, as the edematous center pushes follicles outward." — Jennifer Dietrich (clinical) [Ep 2 · 7:15](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=435)
- "Complete absence of blood flow on ultrasound is the most concerning and reliable finding for torsion; presence of blood flow is less reliable and does not rule out torsion." — Jennifer Dietrich (clinical) [Ep 2 · 4:29](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=269)
- "Blood flow may be present in torsion because only the tube is torsed (ovary still perfused) or because the torsion is intermittent or loose rather than complete." — Jennifer Dietrich (clinical) [Ep 2 · 4:47](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=287)
- "Intermittent torsion can occur, and if the diagnosis is uncertain, observation with repeat ultrasound may help if the patient declares herself with worsening pain." — Jennifer Dietrich (clinical) [Ep 2 · 6:14](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=374)
- "Lesions 5-6 cm or larger increase the risk of torsion in the setting of symptoms by making the adnexa heavy enough to twist." — Jennifer Dietrich (clinical) [Ep 2 · 8:50](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=530)
- "In prepubertal girls, normal ovaries can torse, and torsion is the most common reason for gynecologic surgery in this age group." — Jennifer Dietrich (epidemiological) [Ep 2 · 9:31](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=571)
- "There is no absolute size cutoff for torsion risk; in a prepubertal child with a normally 1-1.5 cm ovary, even a 2-3 cm cyst can cause torsion." — Jennifer Dietrich (clinical) [Ep 2 · 10:19](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=619)
- "Complex ultrasound features (partly cystic, partly solid), hypervascular flow on Doppler within a lesion, and elevated tumor markers raise concern for malignancy." — Jennifer Dietrich (clinical) [Ep 2 · 11:25](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=685)
- "The tumor marker panel for pediatric ovarian lesions includes alpha-fetoprotein, quantitative beta-HCG, lactate dehydrogenase, and CA-125." — Jennifer Dietrich (guideline) [Ep 2 · 15:06](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=906)
- "CT is useful to distinguish an adnexal lesion from an abscess or appendiceal pathology; MRI is useful to distinguish torsion from müllerian anomalies with hematosalpinx." — Jennifer Dietrich (clinical) [Ep 2 · 12:17](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=737)
- "Studies from Boston Children's show higher ovarian salvage rates when surgery occurs within 24-72 hours of pain onset compared to one week." — Jennifer Dietrich (host_summary) [Ep 2 · 17:26](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1046)
- "It is impossible to predict preoperatively whether a torsion is loose (more time available) or tight (rapid ischemia), so suspected torsion should be addressed as soon as the diagnosis is made." — Jennifer Dietrich (clinical) [Ep 2 · 17:52](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1072)
- "If clinical suspicion for torsion is high, it is a clinical diagnosis and surgery should proceed regardless of ultrasound findings; if uncertain, observation with potential repeat imaging is acceptable but the patient should not be sent home." — Jennifer Dietrich (guideline) [Ep 2 · 18:47](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1127)
- "A classic torsion presentation includes acute onset pain after vigorous physical activity (gymnastics, bouncing on a boat), persistent pain unresponsive to over-the-counter measures, nausea and vomiting, and an enlarged ovary on the symptomatic side." — Jennifer Dietrich (clinical) [Ep 2 · 19:52](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1192)
- "Hemorrhagic ovarian cysts are more likely in menstruating females; menstrual history (regularity, timing of last cycle) helps determine risk for hemorrhagic or corpus luteum cysts." — Jennifer Dietrich (clinical) [Ep 2 · 21:22](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1282)
- "In hemorrhagic cysts, Doppler shows no flow within the cyst itself but flow peripheral to the cyst, which can help differentiate from torsion." — Jennifer Dietrich (clinical) [Ep 2 · 22:09](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1329)
- "Surgical management of torsion includes detorsion and removal of any causative lesion (ovarian or peritubal cyst) to eliminate the weight that caused torsion." — Jennifer Dietrich (clinical) [Ep 2 · 22:51](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1371)
- "Oophorectomy and salpingo-oophorectomy should be avoided; the goal is ovarian salvage even when the ovary appears purple, black, and blue, as many recover over time." — Jennifer Dietrich (guideline) [Ep 2 · 23:16](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1396)
- "For ovarian cysts, cystectomy (complete excision of cyst wall) is preferred over drainage alone; peritubal cysts will recur if not completely excised." — Jennifer Dietrich (clinical) [Ep 2 · 23:49](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1429)
- "For peritubal cysts, open the mesosalpinx beneath the splayed fallopian tube, expose the cyst wall, and shell it out." — Jennifer Dietrich (clinical) [Ep 2 · 24:29](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1469)
- "For hemorrhagic ovarian cysts, if the cyst wall is not completely removed, the cyst may continue to bleed." — Jennifer Dietrich (clinical) [Ep 2 · 25:21](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1521)
- "Even necrotic-appearing ovaries should be salvaged unless the tissue is literally falling apart during detorsion; follow-up studies show return of ovarian function and follicles within months." — Jennifer Dietrich (clinical) [Ep 2 · 26:20](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1580)
- "Whether to remove a necrotic fallopian tube depends on whether it is involved in the torsion and completely devitalized; this is a judgment call at the time of surgery." — Jennifer Dietrich (clinical) [Ep 2 · 27:35](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1655)
- "Ovarian bivalving involves making an incision into the ovarian cortex after detorsion to release compartment syndrome-like pressure and improve blood supply to the periphery." — Jennifer Dietrich (clinical) [Ep 2 · 27:56](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1676)
- "Bivalving is indicated when the ovary remains edematous after detorsion, when there is no lesion to remove but the ovary is bulky and at risk for re-torsion, or when debulking is needed after cystectomy." — Jennifer Dietrich (clinical) [Ep 2 · 28:48](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1728)
- "Energy devices such as harmonic scalpel or monopolar hook can be used for ovarian bivalving and debulking." — Jennifer Dietrich (clinical) [Ep 2 · 29:49](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1789)
- "Oophoropexy is considered in cases of recurrent torsion, when a patient has only one ovary, or when the ovary remains at high risk for re-torsion after addressing the primary pathology." — Jennifer Dietrich (clinical) [Ep 2 · 30:53](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1853)
- "Oophoropexy may change future fertility potential by altering ovarian position, but preserving the ovary is better than losing it, and IVF remains an option." — Jennifer Dietrich (opinion) [Ep 2 · 31:18](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1878)
- "Absorbable suture can be used for oophoropexy to hold the adnexa still for 4-6 weeks while inflammation resolves, minimizing near-term re-torsion risk; permanent suture is used for long-term fixation." — Jennifer Dietrich (clinical) [Ep 2 · 31:54](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1914)
- "Clipping the utero-ovarian ligament does not reliably prevent torsion because the adnexa can still twist on either the utero-ovarian ligament or the infundibulopelvic ligament." — Jennifer Dietrich (clinical) [Ep 2 · 32:37](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1957)
- "Oophoropexy techniques include shortening the utero-ovarian ligament (by suturing or clipping it in an accordioned fashion), pexing to the pelvic sidewall (away from ureters), or pexing to the posterior uterus." — Jennifer Dietrich (clinical) [Ep 2 · 33:10](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1990)
- "For tubo-ovarian abscess, antibiotics should be started and the abscess should not be disturbed surgically unless the patient is unstable, to avoid seeding other pelvic structures." — Jennifer Dietrich (guideline) [Ep 2 · 35:14](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2114)
- "Ectopic pregnancy can present similarly to torsion with acute pain and an adnexal mass; surgery is indicated for ruptured or unstable ectopic regardless of pregnancy status." — Jennifer Dietrich (clinical) [Ep 2 · 35:57](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2157)
- "Transvaginal ultrasound is more sensitive than transabdominal for detecting early pregnancy, but many children's hospitals do not perform or have access to transvaginal probes." — Jennifer Dietrich (clinical) [Ep 2 · 37:15](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2235)
- "For tubal ectopic pregnancy, perform salpingostomy (longitudinal incision), remove the ectopic pregnancy, ensure hemostasis, and do not suture the tube closed; pelvic structures heal well without suturing and suturing may cause stricture." — Jennifer Dietrich (clinical) [Ep 2 · 38:07](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2287)
- "Endometriosis in adolescents presents with early lesions that are clear or red rather than the classic blue-black lesions seen in adults with advanced disease." — Jennifer Dietrich (clinical) [Ep 2 · 39:57](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2397)
- "To visualize clear endometriosis lesions, fill the pelvis with crystalloid fluid and dive the camera under to see bleb-like lesions pulling away from the peritoneum, particularly in the cul-de-sac." — Jennifer Dietrich (clinical) [Ep 2 · 40:55](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2455)
- "Endometriosis lesions can be excised with cold scissors (especially near ureter or bowel) or ablated depending on location." — Jennifer Dietrich (clinical) [Ep 2 · 41:52](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2512)
- "After laparoscopic management of torsion, patients can be discharged the same day if they meet milestones, with activity restriction for 4-6 weeks to allow incision healing and avoid hernia formation." — Jennifer Dietrich (guideline) [Ep 2 · 42:22](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2542)
- "Oral contraceptives can prevent recurrence if the torsion was caused by a functional cyst, but they do not prevent recurrence from dermoid cysts or peritubal cysts." — Jennifer Dietrich (clinical) [Ep 2 · 43:31](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2611)
- "Surveillance ultrasound is performed at 3 months postoperatively (to allow inflammation to resolve), then at 3-6 months if the ovary is still recovering, then annually." — Jennifer Dietrich (guideline) [Ep 2 · 43:58](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2638)
- "Ultrasound is a horrible test for torsion according to a pediatric radiologist who was president of the Pediatric Radiology Society" (host_summary) [Ep 1 · 0:46](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=46)
- "Ultrasound is good at identifying the mass and enlarged ovary but should never provide comfort that torsion is not present" (clinical) [Ep 1 · 1:07](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=67)
- "The presence or absence of flow to the ovary on ultrasound should not provide comfort that the patient does not have torsion" (clinical) [Ep 1 · 1:07](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=67)
- "Ultrasound for ovarian torsion is a coin flip in terms of whether vascular flow is seen" — Todd Ponsky (host_summary) [Ep 1 · 1:29](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=89)
- "Black, apparently dead ovaries should be left in place after detorsion" (host_summary) [Ep 1 · 2:35](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=155)
- "A study is underway to improve diagnostic accuracy for torsion and create a scoring system to decrease negative laparoscopies" (clinical) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=180)
- "In 2018, there is no better diagnostic test for torsion than clinical suspicion leading to laparoscopy" (clinical) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=180)
- "When an ovary is malignant, removal is appropriate" — Todd Ponsky (host_summary) [Ep 1 · 5:01](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=301)
- "Clinical assessment at the time of operation is unreliable in determining the presence of viable ovarian cortical tissue" — Todd Ponsky (host_summary) [Ep 1 · 6:18](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=378)
- "Serial ultrasounds after leaving black ovaries in place have shown follicles, indicating functional ovarian tissue was present" — Todd Ponsky (clinical) [Ep 1 · 6:18](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=378)
- "For a torsed ovary with a dermoid cyst, the strategy is to detorse, leave the mass in situ, follow with ultrasound to see if the ovary survives, and return to remove the cyst if it does" (clinical) [Ep 1 · 7:29](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=449)
- "Ultrasound follow-up over approximately 6 weeks is used to determine if a detorsed ovary survives" (clinical) [Ep 1 · 7:29](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=449)
- "Kate Dean has funding from the Thrasher Foundation through the Midwest Pediatric Surgeon Consortium to study an algorithm using tumor markers, size, and radiologic confirmation to determine if ovarian masses are benign" — Todd Ponsky (host_summary) [Ep 1 · 9:10](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=550)
- "Masses in association with ovarian torsion occur in approximately 20% of cases" (epidemiological) [Ep 1 · 11:02](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=662)
- "The risk of malignancy in ovarian masses associated with torsion is very low" (epidemiological) [Ep 1 · 11:02](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=662)
- "The strategy for torsion with a mass is to detorse the ovary, and if the mass can be dealt with at that time with ovarian-sparing surgery, that is acceptable; otherwise close and return after monitoring" (clinical) [Ep 1 · 11:02](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=662)
- "There is no urgency in deciding about mass removal; tumor markers can be obtained, the case can be taken to tumor board, and the decision can be made in a non-emergent fashion" — Todd Ponsky (clinical) [Ep 1 · 11:49](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=709)
- "Laparoscopic ovarian-sparing mass resection has technical challenges; a Pfannenstiel incision may be easier for palpation and dissection" (clinical) [Ep 1 · 12:12](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=732)
- "In ovarian torsion, detorsion should be addressed first, and the mass is a separate issue to be dealt with using ovarian-sparing surgery" (clinical) [Ep 1 · 12:49](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=769)
- "If a Pfannenstiel incision is needed to accomplish ovarian-sparing surgery, that is preferable to oophorectomy" (clinical) [Ep 1 · 12:49](https://library.globalcastmd.com/watch/ovarian-salvage-practice-gap-discussion-at-update-344?t=769)

## Changelog
- Sep 15: Published again automatically — condition is back above threshold
- Sep 15: 1 item added automatically
- Sep 15: 1 item no longer name ovarian torsion
- Sep 9: Unpublished automatically — folded or below threshold
- Sep 7: 3 items added automatically

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