Jennifer Dietrich

215 timestamped statements across 2 collections — auto-found in recorded discussions, each timestamp jumps to the exact moment.

Single Ventricle / HLHS · guest expert

Featured diaries

▶ Ep 1 · 4:47
if a patient has that clinical picture, you know, is in significant pain, has, you know, a good story for an acute onset of pain that's really kind of been progressively worsening and certainly perhaps with nausea or vomiting, fever, those types of things, in addition to finding abnormalities on the side she's experiencing pain on the ultrasound, we're going to be much, much more worried about a torsion, whether or not they report that there's presence of blood flow
quote · Appendicitis
▶ Ep 19 · 4:47
if a patient has that clinical picture, you know, is in significant pain, has, you know, a good story for an acute onset of pain that's really kind of been progressively worsening and certainly perhaps with nausea or vomiting, fever, those types of things, in addition to finding abnormalities on the side she's experiencing pain on the ultrasound, we're going to be much, much more worried about a torsion, whether or not they report that there's presence of blood flow
quote · Single Ventricle / HLHS
▶ Ep 19 · 4:47
if a patient has that clinical picture, you know, is in significant pain, has, you know, a good story for an acute onset of pain that's really kind of been progressively worsening and certainly perhaps with nausea or vomiting, fever, those types of things, in addition to finding abnormalities on the side she's experiencing pain on the ultrasound, we're going to be much, much more worried about a torsion, whether or not they report that there's presence of blood flow
quote · Single Ventricle / HLHS
▶ Ep 1 · 26:47
remarkably, even at our own institution we've done some follow-up studies on just a small subset of patients who've had an ovarian torsion, and you know, people have return of ovarian function, those that were already pubertal, and evidence of follicles. And so sometimes it just takes a few months for things to kind of get back to normalcy.
quote · Appendicitis

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Appendicitis 49 entries

Ovarian Torsion with Dr. Jennifer Dietrich

▶ Ep 1 · 2:02
guideline In all reproductive age females presenting with lower abdominal pain, pregnancy testing is mandatory regardless of sexual activity history ↗
▶ Ep 1 · 4:33
clinical Complete absence of blood flow on ultrasound is the most concerning finding and is more reliable than presence of blood flow ↗
▶ Ep 1 · 4:33
quote the complete absence of blood flow is the most concerning and is more reliable. The presence of blood flow is actually less reliable, believe it or not, on an ultrasound. ↗
▶ Ep 1 · 4:42
clinical Presence of blood flow on ultrasound is less reliable and does not exclude torsion because it could represent a torsed tube with preserved ovarian flow ↗
▶ Ep 1 · 4:47
quote if a patient has that clinical picture, you know, is in significant pain, has, you know, a good story for an acute onset of pain that's really kind of been progressively worsening and certainly perhaps with nausea or vomiting, fever, those types of things, in addition to finding abnormalities on the side she's experiencing pain on the ultrasound, we're going to be much, much more worried about a torsion, whether or not they report that there's presence of blood flow ↗
▶ Ep 1 · 6:14
clinical Intermittent torsion can occur where the ovary twists and untwists, showing normal flow at the time of ultrasound ↗
▶ Ep 1 · 7:15
clinical When ovary is edematous from torsion, follicles become peripheralized to the ovarian periphery due to vascular congestion in the central ovary ↗
▶ Ep 1 · 8:50
clinical Cysts 5-6 centimeters or larger increase suspicion for torsion in the setting of symptoms because they make the ovary and tube heavy enough to twist ↗
▶ Ep 1 · 9:31
epidemiological In prepubertal girls, normal ovaries can torse and torsion is the most common reason for gynecologic surgery in this age group ↗
▶ Ep 1 · 10:19
clinical There is no specific size cutoff for torsion risk; prepubertal ovaries may be only 1-1.5 cm but can still torse ↗
▶ Ep 1 · 11:39
clinical Complex ultrasound features (partly cystic, partly solid) with hypervascular flow on Doppler raise concern for malignancy ↗
▶ Ep 1 · 15:06
guideline Tumor markers for pediatric ovarian masses include alpha-fetoprotein, quantitative beta-HCG, lactate dehydrogenase, and CA-125 ↗
▶ Ep 1 · 17:26
clinical Salvage rates are higher within the first 24-72 hours of pain onset compared to patients presenting after one week ↗
▶ Ep 1 · 17:52
clinical It is impossible to predict which patients have loose versus tight torsion, and tight torsion can develop ischemia quickly ↗
▶ Ep 1 · 17:52
quote you just can't predict sometimes unfortunately is who has a loose torsion and has a bit more time versus who has a really tight torsion and is really going to have ischemia develop quickly. ↗
▶ Ep 1 · 18:47
quote if really your clinical suspicion is high, it is a clinical diagnosis, and you should act on that. ↗
▶ Ep 1 · 18:47
guideline Ovarian torsion is a clinical diagnosis; if clinical suspicion is high, surgery should proceed regardless of ultrasound findings ↗
▶ Ep 1 · 18:56
guideline Patients with equivocal presentation can be observed in hospital for a few hours to see if they declare themselves, but should not be sent home ↗
▶ Ep 1 · 19:26
quote I mean, don't hesitate to observe a patient if it's, if it's unclear. I mean, I wouldn't just send them home ↗
▶ Ep 1 · 19:52
clinical Classic torsion presentation includes acute onset pain after physical activity (gymnastics, cartwheels), persistent pain unresponsive to over-the-counter measures, with nausea and vomiting ↗
▶ Ep 1 · 21:22
clinical Hemorrhagic ovarian cysts are more likely in menstruating females, and menstrual history helps distinguish from torsion ↗
▶ Ep 1 · 22:16
clinical For hemorrhagic cysts, Doppler shows no flow within the cyst itself but preserved peripheral flow around the cyst ↗
▶ Ep 1 · 22:51
guideline Surgical management includes detorsion and removal of causative lesions (ovarian or paratubal cysts) to eliminate the weight that caused torsion ↗
▶ Ep 1 · 23:16
guideline Oophorectomy and salpingo-oophorectomy should be avoided at all times; attempt salvage even of purple, black and blue ovaries ↗
▶ Ep 1 · 23:35
quote You'd be surprised how many, many purple, black and blue ovaries recover over time. ↗
▶ Ep 1 · 24:01
guideline Cystectomy rather than simple drainage is performed for non-functional cysts to prevent recurrence, particularly important for paratubal cysts ↗
▶ Ep 1 · 25:21
clinical For hemorrhagic cysts, if the entire cyst wall is not removed, the cyst may continue to bleed ↗
▶ Ep 1 · 26:20
guideline Even necrotic-appearing ovaries should be salvaged unless the tissue is literally falling apart during detorsion ↗
▶ Ep 1 · 26:34
quote We attempt to leave it. And so really unless that ovary and or tube are kind of just literally as you're trying to untwist the adnexa, it's just kind of falling apart. We, we try to salvage it. ↗
▶ Ep 1 · 26:47
quote remarkably, even at our own institution we've done some follow-up studies on just a small subset of patients who've had an ovarian torsion, and you know, people have return of ovarian function, those that were already pubertal, and evidence of follicles. And so sometimes it just takes a few months for things to kind of get back to normalcy. ↗
▶ Ep 1 · 26:47
clinical Follow-up studies show return of ovarian function and follicle development even after salvage of necrotic-appearing ovaries, sometimes taking a few months ↗
▶ Ep 1 · 28:02
clinical Ovarian bivalving involves making an incision into the ovarian cortex after detorsion to release compartment syndrome-like pressure and improve peripheral blood supply ↗
▶ Ep 1 · 28:48
guideline Bivalving is indicated when the ovary remains edematous after detorsion, particularly in normal ovaries without a lesion to remove ↗
▶ Ep 1 · 29:23
clinical Ovarian debulking via biopsy may be needed if bivalving alone does not adequately decompress a bulky ovary at risk for re-torsion ↗
▶ Ep 1 · 30:53
guideline Oophoropexy is considered in patients who have lost one ovary and present with torsion of the remaining ovary, or in recurrent torsion cases ↗
▶ Ep 1 · 31:18
opinion Oophoropexy changes the position of the ovary which may affect future fertility, but preserving the ovary is better than losing it ↗
▶ Ep 1 · 31:54
clinical Absorbable suture can be used for oophoropexy to hold the adnexa still for 4-6 weeks during inflammation resolution, minimizing near-term re-torsion risk ↗
▶ Ep 1 · 32:37
clinical Clipping the utero-ovarian ligament does not prevent torsion because the ovary can still twist on either the utero-ovarian or infundibulopelvic ligament ↗
▶ Ep 1 · 33:10
clinical Oophoropexy techniques include shortening the utero-ovarian ligament, pexing to the pelvic sidewall (away from ureters), or pexing to the posterior uterus ↗
▶ Ep 1 · 35:14
guideline For tubal-ovarian abscess, antibiotics should be started and surgical intervention avoided unless the patient is clinically unstable, to prevent spreading infection ↗
▶ Ep 1 · 35:57
clinical Ectopic pregnancy can present similarly to ovarian torsion with acute pain and adnexal mass, and may not be visible on transabdominal ultrasound in early pregnancy ↗
▶ Ep 1 · 38:37
clinical Ectopic pregnancy is managed with salpingostomy (longitudinal incision in the tube) to remove the pregnancy; the tube is not sutured closed as it heals well without sutures ↗
▶ Ep 1 · 39:57
clinical Adolescent endometriosis presents with early lesions that are clear or red rather than the classic blue/black lesions seen in adults ↗
▶ Ep 1 · 40:55
clinical Clear endometriosis lesions can be visualized by filling the pelvis with crystalloid and examining underwater with the camera ↗
▶ Ep 1 · 41:52
guideline Endometriosis lesions near the ureter or bowel should be excised with cold scissors rather than cauterized ↗
▶ Ep 1 · 42:22
guideline Patients meeting postoperative milestones can be discharged within a few hours after laparoscopic surgery for torsion ↗
▶ Ep 1 · 42:57
guideline Activity should be limited for 4-6 weeks postoperatively to allow incision healing and avoid hernia formation ↗
▶ Ep 1 · 43:35
clinical Oral contraceptives can prevent recurrence if torsion was caused by a functional cyst, but do not prevent torsion from dermoid or paratubal cysts ↗
▶ Ep 1 · 44:32
guideline Surveillance ultrasound is performed at 3 months post-surgery as it takes several months for inflammation to resolve, then repeated at 3-6 months if recovery is ongoing, then annually ↗
Single Ventricle / HLHS 166 entries

Ovarian Torsion with Dr. Jennifer Dietrich

▶ Ep 19 · 1:48
guideline In all reproductive age females presenting with lower abdominal pain, a pregnancy test should be checked regardless of sexual activity history. ↗
▶ Ep 19 · 1:48
guideline In all reproductive age females presenting with lower abdominal pain, a pregnancy test should be checked regardless of sexual activity history. ↗
▶ Ep 19 · 2:57
clinical Ultrasound provides adequate penetration for ovarian evaluation in both low and high BMI females when the patient has a full bladder. ↗
▶ Ep 19 · 2:57
clinical Ultrasound provides adequate penetration for ovarian evaluation in both low and high BMI females when the patient has a full bladder. ↗
▶ Ep 19 · 3:31
clinical Significant asymmetry between ovaries on ultrasound, particularly enlargement on the symptomatic side, raises concern for adnexal torsion. ↗
▶ Ep 19 · 3:31
clinical Significant asymmetry between ovaries on ultrasound, particularly enlargement on the symptomatic side, raises concern for adnexal torsion. ↗
▶ Ep 19 · 4:29
clinical 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. ↗
▶ Ep 19 · 4:29
clinical 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. ↗
▶ Ep 19 · 4:33
quote the complete absence of blood flow is the most concerning and is more reliable. The presence of blood flow is actually less reliable, believe it or not, on an ultrasound. ↗
▶ Ep 19 · 4:33
quote the complete absence of blood flow is the most concerning and is more reliable. The presence of blood flow is actually less reliable, believe it or not, on an ultrasound. ↗
▶ Ep 19 · 4:47
quote if a patient has that clinical picture, you know, is in significant pain, has, you know, a good story for an acute onset of pain that's really kind of been progressively worsening and certainly perhaps with nausea or vomiting, fever, those types of things, in addition to finding abnormalities on the side she's experiencing pain on the ultrasound, we're going to be much, much more worried about a torsion, whether or not they report that there's presence of blood flow ↗
▶ Ep 19 · 4:47
clinical 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. ↗
▶ Ep 19 · 4:47
quote if a patient has that clinical picture, you know, is in significant pain, has, you know, a good story for an acute onset of pain that's really kind of been progressively worsening and certainly perhaps with nausea or vomiting, fever, those types of things, in addition to finding abnormalities on the side she's experiencing pain on the ultrasound, we're going to be much, much more worried about a torsion, whether or not they report that there's presence of blood flow ↗
▶ Ep 19 · 4:47
clinical 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. ↗
▶ Ep 19 · 6:14
clinical Intermittent torsion can occur, and if the diagnosis is uncertain, observation with repeat ultrasound may help if the patient declares herself with worsening pain. ↗
▶ Ep 19 · 6:14
clinical Intermittent torsion can occur, and if the diagnosis is uncertain, observation with repeat ultrasound may help if the patient declares herself with worsening pain. ↗
▶ Ep 19 · 7:15
clinical Peripheralization of follicles to the ovarian periphery suggests vascular congestion from torsion, as the edematous center pushes follicles outward. ↗
▶ Ep 19 · 7:15
clinical Peripheralization of follicles to the ovarian periphery suggests vascular congestion from torsion, as the edematous center pushes follicles outward. ↗
▶ Ep 19 · 8:50
clinical Lesions 5-6 cm or larger increase the risk of torsion in the setting of symptoms by making the adnexa heavy enough to twist. ↗
▶ Ep 19 · 8:50
clinical Lesions 5-6 cm or larger increase the risk of torsion in the setting of symptoms by making the adnexa heavy enough to twist. ↗
▶ Ep 19 · 9:31
quote in prepubertal girls, sometimes it was a normal ovary that was tors and the the most. Often the reason that those little girls actually went to surgery for a gynecologic reason was because we found a torsd ovary in a prepubertal child. ↗
▶ Ep 19 · 9:31
epidemiological In prepubertal girls, normal ovaries can torse, and torsion is the most common reason for gynecologic surgery in this age group. ↗
▶ Ep 19 · 9:31
quote in prepubertal girls, sometimes it was a normal ovary that was tors and the the most. Often the reason that those little girls actually went to surgery for a gynecologic reason was because we found a torsd ovary in a prepubertal child. ↗
▶ Ep 19 · 9:31
epidemiological In prepubertal girls, normal ovaries can torse, and torsion is the most common reason for gynecologic surgery in this age group. ↗
▶ Ep 19 · 10:19
clinical 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. ↗
▶ Ep 19 · 10:19
clinical 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. ↗
▶ Ep 19 · 10:30
quote you know, their ovaries are very tiny and so may only be 1 centimeter, 1.5 cm in total size, but normal ovaries can twist. ↗
▶ Ep 19 · 10:30
quote you know, their ovaries are very tiny and so may only be 1 centimeter, 1.5 cm in total size, but normal ovaries can twist. ↗
▶ Ep 19 · 11:25
clinical Complex ultrasound features (partly cystic, partly solid), hypervascular flow on Doppler within a lesion, and elevated tumor markers raise concern for malignancy. ↗
▶ Ep 19 · 11:25
clinical Complex ultrasound features (partly cystic, partly solid), hypervascular flow on Doppler within a lesion, and elevated tumor markers raise concern for malignancy. ↗
▶ Ep 19 · 12:17
clinical 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. ↗
▶ Ep 19 · 12:17
clinical 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. ↗
▶ Ep 19 · 15:06
guideline The tumor marker panel for pediatric ovarian lesions includes alpha-fetoprotein, quantitative beta-HCG, lactate dehydrogenase, and CA-125. ↗
▶ Ep 19 · 15:06
guideline The tumor marker panel for pediatric ovarian lesions includes alpha-fetoprotein, quantitative beta-HCG, lactate dehydrogenase, and CA-125. ↗
▶ Ep 19 · 17:26
host_summary Studies from Boston Children's show higher ovarian salvage rates when surgery occurs within 24-72 hours of pain onset compared to one week. ↗
▶ Ep 19 · 17:26
epidemiological Studies from Boston Children's show higher ovarian salvage rates when surgery occurs within 24-72 hours of pain onset compared to one week. ↗
▶ Ep 19 · 17:52
quote the one thing you just can't predict sometimes unfortunately is who has a loose torsion and has a bit more time versus who has a really tight torsion and is really going to have ischemia develop quickly. ↗
▶ Ep 19 · 17:52
quote the one thing you just can't predict sometimes unfortunately is who has a loose torsion and has a bit more time versus who has a really tight torsion and is really going to have ischemia develop quickly. ↗
▶ Ep 19 · 17:52
clinical 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. ↗
▶ Ep 19 · 17:52
clinical 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. ↗
▶ Ep 19 · 18:47
quote if really your clinical suspicion is high, it is a clinical diagnosis, and you should act on that. ↗
▶ Ep 19 · 18:47
guideline 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. ↗
▶ Ep 19 · 18:47
guideline 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. ↗
▶ Ep 19 · 18:47
quote if really your clinical suspicion is high, it is a clinical diagnosis, and you should act on that. ↗
▶ Ep 19 · 19:26
quote I mean, don't hesitate to observe a patient if it's, if it's unclear. I mean, I wouldn't just send them home ↗
▶ Ep 19 · 19:26
quote I mean, don't hesitate to observe a patient if it's, if it's unclear. I mean, I wouldn't just send them home ↗
▶ Ep 19 · 19:52
clinical 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. ↗
▶ Ep 19 · 19:52
clinical 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. ↗
▶ Ep 19 · 21:22
clinical 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. ↗
▶ Ep 19 · 21:22
clinical 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. ↗
▶ Ep 19 · 22:09
clinical In hemorrhagic cysts, Doppler shows no flow within the cyst itself but flow peripheral to the cyst, which can help differentiate from torsion. ↗
▶ Ep 19 · 22:09
clinical In hemorrhagic cysts, Doppler shows no flow within the cyst itself but flow peripheral to the cyst, which can help differentiate from torsion. ↗
▶ Ep 19 · 22:51
clinical Surgical management of torsion includes detorsion and removal of any causative lesion (ovarian or peritubal cyst) to eliminate the weight that caused torsion. ↗
▶ Ep 19 · 22:51
quote we are going to detour the ovary, obviously, and you know if we see a lesion such as a peritubal cyst or an ovarian cyst, we are going to take it out. ↗
▶ Ep 19 · 22:51
clinical Surgical management of torsion includes detorsion and removal of any causative lesion (ovarian or peritubal cyst) to eliminate the weight that caused torsion. ↗
▶ Ep 19 · 22:51
quote we are going to detour the ovary, obviously, and you know if we see a lesion such as a peritubal cyst or an ovarian cyst, we are going to take it out. ↗
▶ Ep 19 · 23:16
guideline 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. ↗
▶ Ep 19 · 23:16
quote we want to try to avoid an oophorectomy and a salpingo oophorectomy at all times. And so we really try to save it, you know, once you untwist it, give it time, and You'd be surprised how many, many purple, black and blue ovaries recover over time. ↗
▶ Ep 19 · 23:16
guideline 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. ↗
▶ Ep 19 · 23:16
quote we want to try to avoid an oophorectomy and a salpingo oophorectomy at all times. And so we really try to save it, you know, once you untwist it, give it time, and You'd be surprised how many, many purple, black and blue ovaries recover over time. ↗
▶ Ep 19 · 23:49
clinical For ovarian cysts, cystectomy (complete excision of cyst wall) is preferred over drainage alone; peritubal cysts will recur if not completely excised. ↗
▶ Ep 19 · 23:49
clinical For ovarian cysts, cystectomy (complete excision of cyst wall) is preferred over drainage alone; peritubal cysts will recur if not completely excised. ↗
▶ Ep 19 · 24:29
clinical For peritubal cysts, open the mesosalpinx beneath the splayed fallopian tube, expose the cyst wall, and shell it out. ↗
▶ Ep 19 · 24:29
clinical For peritubal cysts, open the mesosalpinx beneath the splayed fallopian tube, expose the cyst wall, and shell it out. ↗
▶ Ep 19 · 25:21
clinical For hemorrhagic ovarian cysts, if the cyst wall is not completely removed, the cyst may continue to bleed. ↗
▶ Ep 19 · 25:21
clinical For hemorrhagic ovarian cysts, if the cyst wall is not completely removed, the cyst may continue to bleed. ↗
▶ Ep 19 · 26:20
quote I would still try to save it. And so, you know, detourse it, give it some time, try to address an ovarian or peritubal lesion if you see one, and you know, we attempt to leave it. And so really unless that ovary and or tube are kind of just literally as you're trying to untwist the adnexa, it's just kind of falling apart. We, we try to salvage it. ↗
▶ Ep 19 · 26:20
quote I would still try to save it. And so, you know, detourse it, give it some time, try to address an ovarian or peritubal lesion if you see one, and you know, we attempt to leave it. And so really unless that ovary and or tube are kind of just literally as you're trying to untwist the adnexa, it's just kind of falling apart. We, we try to salvage it. ↗
▶ Ep 19 · 26:20
clinical 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. ↗
▶ Ep 19 · 26:20
clinical 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. ↗
▶ Ep 19 · 26:47
quote remarkably, even at our own institution we've done some follow-up studies on just a small subset of patients who've had an ovarian torsion, and you know, people have return of ovarian function, those that were already pubertal, and evidence of follicles. And so sometimes it just takes a few months for things to kind of get back to normalcy. ↗
▶ Ep 19 · 26:47
quote remarkably, even at our own institution we've done some follow-up studies on just a small subset of patients who've had an ovarian torsion, and you know, people have return of ovarian function, those that were already pubertal, and evidence of follicles. And so sometimes it just takes a few months for things to kind of get back to normalcy. ↗
▶ Ep 19 · 27:35
clinical 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. ↗
▶ Ep 19 · 27:35
clinical 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. ↗
▶ Ep 19 · 27:56
clinical 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. ↗
▶ Ep 19 · 27:56
clinical 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. ↗
▶ Ep 19 · 28:48
clinical 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. ↗
▶ Ep 19 · 28:48
clinical 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. ↗
▶ Ep 19 · 29:49
clinical Energy devices such as harmonic scalpel or monopolar hook can be used for ovarian bivalving and debulking. ↗
▶ Ep 19 · 29:49
clinical Energy devices such as harmonic scalpel or monopolar hook can be used for ovarian bivalving and debulking. ↗
▶ Ep 19 · 30:53
clinical 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. ↗
▶ Ep 19 · 30:53
clinical 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. ↗
▶ Ep 19 · 31:18
opinion Oophoropexy may change future fertility potential by altering ovarian position, but preserving the ovary is better than losing it, and IVF remains an option. ↗
▶ Ep 19 · 31:18
opinion Oophoropexy may change future fertility potential by altering ovarian position, but preserving the ovary is better than losing it, and IVF remains an option. ↗
▶ Ep 19 · 31:54
clinical 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. ↗
▶ Ep 19 · 31:54
clinical 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. ↗
▶ Ep 19 · 32:37
clinical 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. ↗
▶ Ep 19 · 32:37
clinical 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. ↗
▶ Ep 19 · 33:10
clinical 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. ↗
▶ Ep 19 · 33:10
clinical 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. ↗
▶ Ep 19 · 35:14
guideline 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. ↗
▶ Ep 19 · 35:14
guideline 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. ↗
▶ Ep 19 · 35:57
clinical 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. ↗
▶ Ep 19 · 35:57
clinical 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. ↗
▶ Ep 19 · 37:15
clinical 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. ↗
▶ Ep 19 · 37:15
clinical 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. ↗
▶ Ep 19 · 38:07
clinical 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. ↗
▶ Ep 19 · 38:07
clinical 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. ↗
▶ Ep 19 · 39:57
clinical 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. ↗
▶ Ep 19 · 39:57
clinical 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. ↗
▶ Ep 19 · 40:55
clinical 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. ↗
▶ Ep 19 · 40:55
clinical 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. ↗
▶ Ep 19 · 41:52
clinical Endometriosis lesions can be excised with cold scissors (especially near ureter or bowel) or ablated depending on location. ↗
▶ Ep 19 · 41:52
clinical Endometriosis lesions can be excised with cold scissors (especially near ureter or bowel) or ablated depending on location. ↗
▶ Ep 19 · 42:22
guideline 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. ↗
▶ Ep 19 · 42:22
guideline 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. ↗
▶ Ep 19 · 43:31
clinical 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. ↗
▶ Ep 19 · 43:31
clinical 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. ↗
▶ Ep 19 · 43:58
guideline 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. ↗
▶ Ep 19 · 43:58
guideline 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. ↗

Ovarian Torsion with Dr. Jennifer Dietrich

▶ Ep 28 · 2:02
guideline In all reproductive age females presenting with lower abdominal pain, a pregnancy test should be checked regardless of sexual history. ↗
▶ Ep 28 · 2:57
clinical Ultrasound provides real-time and still pictures with better penetration capabilities regardless of patient BMI, as long as the female has a full bladder. ↗
▶ Ep 28 · 3:31
clinical Significant asymmetry between ovaries on ultrasound, particularly enlargement on the side of pain, raises concern for adnexal torsion. ↗
▶ Ep 28 · 4:33
clinical 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. ↗
▶ Ep 28 · 4:33
quote The complete absence of blood flow is the most concerning and is more reliable. The presence of blood flow is actually less reliable, believe it or not, on an ultrasound. ↗
▶ Ep 28 · 5:00
clinical 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. ↗
▶ Ep 28 · 6:14
clinical Intermittent torsion can occur, and if diagnosis is difficult, observation with repeat ultrasound may help if the patient's condition declares itself. ↗
▶ Ep 28 · 7:15
clinical When the ovary is edematous with compromised blood supply, follicles become peripheralized to the ovary's periphery due to vascular congestion in the middle. ↗
▶ Ep 28 · 8:50
clinical 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. ↗
▶ Ep 28 · 9:31
epidemiological In prepubertal girls, normal ovaries can torse, and torsion is the most common reason these children undergo surgery for a gynecologic indication. ↗
▶ Ep 28 · 10:19
clinical 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. ↗
▶ Ep 28 · 11:24
clinical Complex features on ultrasound (partly cystic, partly solid) with hypervascular flow within the lesion and elevated tumor markers raise concern for malignancy. ↗
▶ Ep 28 · 12:17
clinical CT is beneficial to distinguish an adnexal lesion from an abscess or appendiceal pathology when infection is a concern. ↗
▶ Ep 28 · 12:36
clinical MRI is useful to distinguish torsion from Müllerian anomalies with outflow tract obstruction, where a hematosalpinx may mimic torsion on ultrasound. ↗
▶ Ep 28 · 13:19
guideline Pelvic exams in adolescents are typically delayed until later teenage years or until the first Pap smear at age 21, unless specific concerns arise. ↗
▶ Ep 28 · 15:06
clinical Tumor markers sent for complex adnexal masses include alpha-fetoprotein, serum beta-HCG quantitative, lactate dehydrogenase, and CA-125. ↗
▶ Ep 28 · 15:57
clinical 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. ↗
▶ Ep 28 · 17:26
host_summary 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. ↗
▶ Ep 28 · 17:52
clinical 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. ↗
▶ Ep 28 · 18:16
guideline Ovarian torsion is a clinical diagnosis; if clinical suspicion is high, surgery should proceed regardless of ultrasound findings including blood flow. ↗
▶ Ep 28 · 18:47
quote If really your clinical suspicion is high, it is a clinical diagnosis, and you should act on that. ↗
▶ Ep 28 · 18:56
clinical 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. ↗
▶ Ep 28 · 19:26
quote I mean, don't hesitate to observe a patient if it's, if it's unclear. I mean, I wouldn't just send them home. ↗
▶ Ep 28 · 19:52
clinical 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. ↗
▶ Ep 28 · 21:22
clinical 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. ↗
▶ Ep 28 · 22:09
clinical Doppler can help differentiate hemorrhagic cysts from torsion: within a hemorrhagic cyst there is no flow, but peripheral to the cyst there is flow. ↗
▶ Ep 28 · 22:51
clinical 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. ↗
▶ Ep 28 · 23:35
quote You'd be surprised how many, many purple, black and blue ovaries recover over time. ↗
▶ Ep 28 · 23:35
guideline Oophorectomy and salpingo-oophorectomy should be avoided at all times; even purple, black and blue ovaries can recover over time after detorsion. ↗
▶ Ep 28 · 23:35
quote We really try to save it, you know, once you untwist it, give it time. ↗
▶ Ep 28 · 23:49
clinical For non-ischemic torsion, cystectomy is performed rather than simple drainage unless the cyst is clearly functional. ↗
▶ Ep 28 · 24:18
clinical Peritubal cysts will recur if not completely excised; the technique involves opening the mesosalpinx beneath the fallopian tube and shelling out the cyst wall. ↗
▶ Ep 28 · 25:04
clinical 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. ↗
▶ Ep 28 · 25:25
quote The funny thing about a hemorrhagic cyst is that sometimes if you don't get all of the cyst wall, it continues to bleed. ↗
▶ Ep 28 · 26:20
clinical 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. ↗
▶ Ep 28 · 26:47
clinical Follow-up studies at Texas Children's Hospital show return of ovarian function and evidence of follicles in patients who had torsed ovaries preserved. ↗
▶ Ep 28 · 27:35
clinical 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. ↗
▶ Ep 28 · 27:56
host_summary 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. ↗
▶ Ep 28 · 28:48
clinical 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. ↗
▶ Ep 28 · 29:43
clinical Energy devices such as harmonic scalpel or monopolar hook can be used for ovarian bivalving and debulking procedures. ↗
▶ Ep 28 · 30:53
clinical Oophoropexy is considered when a child has lost one ovary and presents with torsion of the remaining ovary, or in cases of recurrent torsion. ↗
▶ Ep 28 · 31:18
opinion Oophoropexy may change future fertility potential, but preserving the ovary is better than losing it; in vitro technologies remain an option for egg retrieval. ↗
▶ Ep 28 · 31:54
clinical 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. ↗
▶ Ep 28 · 32:37
clinical Clipping the utero-ovarian ligament does not always prevent torsion because torsion can occur on either the utero-ovarian ligament or the infundibulopelvic ligament. ↗
▶ Ep 28 · 33:10
clinical 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. ↗
▶ Ep 28 · 35:14
clinical 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. ↗
▶ Ep 28 · 35:57
clinical 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. ↗
▶ Ep 28 · 38:07
clinical 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. ↗
▶ Ep 28 · 38:56
clinical Pelvic structures heal well without suturing; suturing can cause more scar tissue and stricture formation than leaving small incisions to heal on their own. ↗
▶ Ep 28 · 39:57
clinical 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. ↗
▶ Ep 28 · 40:55
quote One little trick to look for clear lesions that almost look like little blebs that are kind of pulling away from the peritoneum is to fill up the pelvis with a little bit of crystalloid fluid and then take your camera and dive under, and you can see things a little bit closer. ↗
▶ Ep 28 · 40:55
clinical 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. ↗
▶ Ep 28 · 41:52
clinical Endometriosis lesions can be excised with cold scissors when near the ureter or bowel, or ablated in other locations. ↗
▶ Ep 28 · 42:22
clinical 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. ↗
▶ Ep 28 · 43:31
clinical 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. ↗
▶ Ep 28 · 44:32
clinical 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. ↗