Ovarian Torsion Rapid Fire: Update Course 2015

Ovarian torsion is most common in teenage girls and is being seen as an urgent rather than emergent situation when aiming to preserve the ovary.

Many black-colored ovaries actually have viable follicles in them, and ovarian preservation should be the goal.

In oophorectomy specimens removed for torsion where the surgeon believed the ovary was dead, 76% had normal ovarian tissue, only 13% had no ovarian tissue, and only 11% were completely necrotic.

Microscopically, ovarian tissue looks very different than it does in the gross setting when a surgeon is looking at the ovary.

Pain is the most commonly reported consequence of oophoropexy, which is usually short-lived and resolves in about a week.

The ability to preserve ovarian function is related to age; in pediatric patients, surgeons should be aggressive about preserving the ovary, but in older adults there are fewer active follicles.

The recommendation is for detorsion without complete oophorectomy.

Ultrasound sensitivity and specificity for blood flow in ovarian torsion is in the 50-60% range.

If the child is in a lot of pain, surgery needs to be done right away; ultrasound blood flow findings should not be relied upon.

Ultrasound blood flow findings are dependent on the pressure the sonographer is using and how much the bladder is filled.

For fertility reasons, placing ovaries behind the uterus during oophoropexy is preferred over lateral placement.