Ovarian Torsion
Everything in the library about ovarian torsion — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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Case-Based Learning
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Ovarian Salvage (Torsion & Benign Tumor): Practice Gap discussion at Update...
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At the 6th Annual Pediatric Surgery Update Course, Drs Charles Snyder, Craig Lillehei and David Powell discussthe top ten practice gaps of 2018. Here they discuss ovarian salvage, focusing on low sensitivity of ultrasound, pursuing laparosc
video14:07 · Sep 2018
In-Depth Reviews
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Ovarian Torsion with Dr. Jennifer Dietrich
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Dr Jennifer E. Dietrich, discusses ovarian torsion with Dr Todd A. Ponsky Edited by Nicholas E. Bruns, MD Ian C. Glenn, MD
podcast47:22 · Jan 2019
Ovarian Torsion with Dr. Jennifer Dietrich
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Dr Jennifer E. Dietrich, discusses ovarian torsion with Dr Todd A. Ponsky Edited by Nicholas E. Bruns, MD & Ian C. Glenn, MDEvaluation of the adolescent female with pelvic painObtain sexual history and urine b-hCGMenstrual history (hemorrha
podcast47:22 · Dec 2020
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Ovarian Torsion with Dr. Jennifer Dietrich
In all reproductive age females presenting with lower abdominal pain, a pregnancy test should be checked regardless of sexual history.
guidelineJennifer Dietrich2:02 ↗
Ultrasound provides real-time and still pictures with better penetration capabilities regardless of patient BMI, as long as the female has a full bladder.
clinicalJennifer Dietrich2:57 ↗
Significant asymmetry between ovaries on ultrasound, particularly enlargement on the side of pain, raises concern for adnexal torsion.
clinicalJennifer Dietrich3:31 ↗
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.
clinicalJennifer Dietrich4:33 ↗
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.
clinicalJennifer Dietrich5:00 ↗
Intermittent torsion can occur, and if diagnosis is difficult, observation with repeat ultrasound may help if the patient's condition declares itself.
clinicalJennifer Dietrich6:14 ↗
When the ovary is edematous with compromised blood supply, follicles become peripheralized to the ovary's periphery due to vascular congestion in the middle.
clinicalJennifer Dietrich7:15 ↗
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.
clinicalJennifer Dietrich8:50 ↗
In prepubertal girls, normal ovaries can torse, and torsion is the most common reason these children undergo surgery for a gynecologic indication.
epidemiologicalJennifer Dietrich9:31 ↗
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.
clinicalJennifer Dietrich10:19 ↗
Complex features on ultrasound (partly cystic, partly solid) with hypervascular flow within the lesion and elevated tumor markers raise concern for malignancy.
clinicalJennifer Dietrich11:24 ↗
CT is beneficial to distinguish an adnexal lesion from an abscess or appendiceal pathology when infection is a concern.
clinicalJennifer Dietrich12:17 ↗
MRI is useful to distinguish torsion from Müllerian anomalies with outflow tract obstruction, where a hematosalpinx may mimic torsion on ultrasound.
clinicalJennifer Dietrich12:36 ↗
Pelvic exams in adolescents are typically delayed until later teenage years or until the first Pap smear at age 21, unless specific concerns arise.
guidelineJennifer Dietrich13:19 ↗
Tumor markers sent for complex adnexal masses include alpha-fetoprotein, serum beta-HCG quantitative, lactate dehydrogenase, and CA-125.
clinicalJennifer Dietrich15:06 ↗
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.
clinicalJennifer Dietrich15:57 ↗
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.
host_summaryJennifer Dietrich17:26 ↗
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.
clinicalJennifer Dietrich17:52 ↗
Ovarian torsion is a clinical diagnosis; if clinical suspicion is high, surgery should proceed regardless of ultrasound findings including blood flow.
guidelineJennifer Dietrich18:16 ↗
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.
clinicalJennifer Dietrich18:56 ↗
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.
clinicalJennifer Dietrich19:52 ↗
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.
clinicalJennifer Dietrich21:22 ↗
Doppler can help differentiate hemorrhagic cysts from torsion: within a hemorrhagic cyst there is no flow, but peripheral to the cyst there is flow.
clinicalJennifer Dietrich22:09 ↗
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.
clinicalJennifer Dietrich22:51 ↗
Oophorectomy and salpingo-oophorectomy should be avoided at all times; even purple, black and blue ovaries can recover over time after detorsion.
guidelineJennifer Dietrich23:35 ↗
For non-ischemic torsion, cystectomy is performed rather than simple drainage unless the cyst is clearly functional.
clinicalJennifer Dietrich23:49 ↗
Peritubal cysts will recur if not completely excised; the technique involves opening the mesosalpinx beneath the fallopian tube and shelling out the cyst wall.
clinicalJennifer Dietrich24:18 ↗
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.
clinicalJennifer Dietrich25:04 ↗
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.
clinicalJennifer Dietrich26:20 ↗
Follow-up studies at Texas Children's Hospital show return of ovarian function and evidence of follicles in patients who had torsed ovaries preserved.
clinicalJennifer Dietrich26:47 ↗
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