Benefits, Harms and Costs
- 1.Ultrasound with and without colour flow Doppler is the imaging modality of choice for any suspected adnexal torsion (II-2).
- 2.Laparoscopy is the preferred surgical approach for adnexal torsion (II-2).
- 3.Ovarian function following detorsion, even in cases of the blue-black ovary, has been consistently documented with colour flow Doppler (II-2).
- 4.The risk of malignancy at the time of torsion, in both the paediatric and adolescent population and adult population, is very low (II-2).
- 1.The diagnosis of adnexal torsion should be considered in females presenting with acute abdominal pain (II-2B).
- 2.Decreased or absent colour Doppler flow, increased total ovarian volume, and abnormal adnexal volume ratios may all be suggestive of adnexal torsion, but the decision to operate should not be based exclusively on sonographic findings (II-2B).
- 3.The theoretical risk of a thromboembolic event following detorsion is unfounded and should not preclude conservative management (II-2B).
- 4.A prompt diagnosis and referral to a surgeon minimizes trauma and ischemia to the ovary when torsion is suspected and surgery should be performed as soon as possible (II-2B).
- 5.Conservative surgical treatment of ovarian torsion, including detorsion with or without cystectomy, should be performed if torsion is confirmed, even in cases of a blue-black ovary (II-2B).
- 6.Delaying the cystectomy should be considered to avoid further insult to the edematous ovary (II-2B).
- 7.An oophorectomy rather than a cystectomy should only be considered in the postmenopausal female population with ovarian torsion, due to the increased risk of malignancy (II-2B).
- 8.Oophoropexy can be considered in situations where the ovarian ligament is congenitally long, patients with repeat torsion, or when no obvious cause for the torsion can be found (III-C).
Abbreviations:CDU (colour Doppler ultrasonography), CRP (C-reactive protein), CT (computed tomography), IL-6 (interleukin-6), MRI (magnetic resonance imaging), PPV (positive predictive value)
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- Adnexal torsion.Am J Obstet Gynecol. 1985; 152: 456-461
- Torsion of normal adnexa in postmenarchal women and risk of recurrence.Obstet Gynecol. 2007; 109: 355-359
- Urgency of evaluation and outcome of acute overian torsion in pediatric patients.Arch Pediatr Adolesc Med. 2005; 159: 532-535
- Ovarian torsion: 10-year perspective.Emerg Med Australas. 2005; 17: 231-237
- Emergency management and conservative surgery of ovarian torsion in children: a report of 40 cases.J Pediatr Adolesc Gynecol. 2008; 21: 201-206
- Pediatric ovarian malignancy presenting as ovarian torsion: incidence and relevance.J Pediatr Surg. 2010; 45: 135-139
- Adnexal torsion: a report on forty-five cases.Eur J Obstet Gynecol Reprod Biol. 2001; 98: 91-96
- Ovarian torsion in children: is oophorectomy necessary?.J Pediatr Surg. 2004; 39: 750-753
- Torsion of malignant ovarian tumors in childhood and adolescence.J Pediatr Endocrinol Metab. 2008; 21: 1073-1078
- The risk of malignancy in post-menopausal women presenting with adnexal torsion.Gynecol Oncol. 2007; 106: 211-214
- Torsion of normal adnexa in postmenarcheal women: can ultrasound indicate an ischemic process?.Ultrasound Obstet Gynecol. 2008; 31: 338-341
- Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women.Surg Gynecol Obstet. 1991; 173: 363-366
- [Diagnosis of adnexal torsion and predictive factors of adnexal necrosis].Gynecol Obstet Fertil. 2005; 33: 102-106
- Subsequent asynchronous torsion of normal adnexa in children.J Pediatr Surg. 1990; 25: 687-689
- Ovarian torsion: a fifteen-year review.Ann Emerg Med. 2001; 38: 156-159
- Key clinical predictors in the early diagnosis of adnexal torsion in children.J Pediatr Adolesc Gynecol. 2013; 26: 167-170
- Acute ovarian torsion in children.Am J Surg. 2000; 180: 462-465
- Risk factors, symptoms, and treatment of ovarian torsion in children: the twelve-year experience of one center.J Minim Invasive Gynecol. 2012; 19: 29-33
- The conservative management of adnexal torsion—a case-report and review of the literature.Eur J Obstet Gynecol Reprod Biol. 2002; 101: 83-86
- Acute increase in plasma D-dimer level in ovarian torsion: an experimental study.Hum Reprod. 2011; 26: 564-568
- Surgical intervention for maternal ovarian torsion in pregnancy.Taiwan J Obstet Gynecol. 2011; 50: 458-462
- Laparoscopy versus laparotomy for surgical intervention of ovarian torsion.J Obstet Gynaecol Res. 2008; 34: 1020-1025
- Ovarian torsion among girls presenting with abdominal pain: a retrospective cohort study.Emerg Med J. 2012; 30: e11
- Predictive factors for ovarian necrosis in torsion of ovarian tumor.Tohoku J Exp Med. 2011; 225: 211-214
- Adnexal torsion: cystectomy and ovarian fixation are equally important in preventing recurrence.Eur J Obstet Gynecol Reprod Biol. 2012; 162: 203-205
- Novel serum inflammatory markers in patients with adnexal mass who had surgery for ovarian torsion.Fertil Steril. 2006; 85: 1469-1472
- The accuracy of serum interleukin-6 and tumour necrosis factor as markers for ovarian torsion.Hum Reprod. 2001; 16: 2195-2197
- Biomarkers to distinguish surgical etiologies in females with lower quadrant abdominal pain.Acad Emerg Med. 2011; 18: 686-691
- Preoperative sonographic and clinical characteristics as predictors of ovarian torsion.J Ultrasound Med. 2008; 27: 7-13
- Sonographic depiction of ovarian vascularity and flow: current improvements and future applications.J Ultrasound Med. 2001; 20: 241-250
- A meta-analysis of B-mode ultrasound, Doppler ultrasound, and computed tomography to diagnose pediatric ovarian torsion.Eur J Pediatr Surg. 2015; 25: 82-86
- Torsion of the ovary: sonographic features.AJR Am J Roentgenol. 1984; 143: 1331-1334
- The positive and negative predictive value of transabdominal color Doppler ultrasound for diagnosing ovarian torsion in pediatric patients.J Pediatr Surg. 2013; 48: 1283-1287
- The effectiveness of spectral and color Doppler in predicting ovarian torsion. A prospective study.Eur J Obstet Gynecol Reprod Biol. 2002; 104: 64-66
- US findings of adnexal torsion in children and adolescents: size really does matter.Pediatr Radiol. 2007; 37: 1013-1019
- Sonographic findings of ovarian torsion in children.Pediatr Radiol. 2007; 37: 446-451
- Conservative therapy of adnexal torsion employing color Doppler sonography.J Am Assoc Gynecol Laparosc. 1998; 5: 13-17
- Sonographic findings in adnexal torsion: a report of 34 cases.Arch Gynecol Obstet. 2009; 279: 841-844
- Value of intra-adnexal and extra-adnexal computed tomographic imaging features diagnosing torsion of adnexal tumor.J Comput Assist Tomogr. 2009; 33: 872-876
- Color Doppler sonography of adnexal torsion.J Ultrasound Med. 1995; 14: 523-528
- Usefulness of Doppler sonography in the diagnosis of ovarian torsion.Fertil Steril. 2000; 73: 1047-1050
- Prevalence of abnormal CT findings in patients with proven ovarian torsion and a proposed triage schema.Emerg Radiol. 2009; 16: 115-120
- MR imaging findings of ovarian torsion correlate with pathological hemorrhagic infarction.J Obstet Gynaecol Res. 2015; 41: 1433-1439
- Laparoscopic detorsion allows sparing of the twisted ischemic adnexa.J Am Assoc Gynecol Laparosc. 1999; 6: 139-143
- Minimal surgery for the twisted ischaemic adnexa can preserve ovarian function.Hum Reprod. 2003; 18: 2599-2602
- Conservative laparoscopic approach to adnexal torsion.Arch Gynecol Obstet. 2008; 277: 535-538
- Long-term results of conservative management of adnexal torsion in children.J Pediatr Surg. 2005; 40: 704-708
- Asynchronous bilateral ovarian torsion.J Pediatr Surg. 2004; 39: 746-749
- Ovarian conservation in adnexal torsion - a report of six cases.Gynecol Surg. 2008; 2008: 137-141
- Recovery of ovarian function after laparoscopic detorsion.Hum Reprod. 1995; 10: 2965-2966
- Ovarian torsion. Management and ovarian prognosis: a report of 45 cases.J Pediatr Surg. 2009; 44: 1759-1765
- Ovarian torsion: diagnosis of inclusion mandates earlier intervention.J Pediatr Surg. 2012; 47: 2071-2076
- The clinical presentation and surgical management of adnexal torsion in the pediatric and adolescent population.J Pediatr Adolesc Gynecol. 2012; 25: 109-113
- Adnexal torsion in children and adolescents: new trends to conservative surgical approach—our experience and review of literature.Gynecol Endocrinol. 2013; 29: 54-58
- Adnexal torsion and pulmonary embolism: case report and review of the literature.Obstet Gynecol Surv. 1999; 54: 601-608
- Treatment of adnexal torsion using operative laparoscopy.Hum Reprod. 1996; 11: 998-1003
- Predominant etiology of adnexal torsion and ovarian outcome after detorsion in premenarchal girls.Eur J Pediatr Surg. 2010; 20: 298-301
- Preservation of ovarian tissue in adnexal torsion with fluorescein.Am J Obstet Gynecol. 1993; 168: 1386-1388
- Ovarian Torsion: Time Limiting Factors for Ovarian Salvage.Emerg Med (Los Angel). 2015; 5: 273
- Adnexal torsion in adolescents: prompt diagnosis and treatment may save the adnexa.Eur J Obstet Gynecol Reprod Biol. 1995; 63: 169-173
- The effects of twisted ischaemic adnexa managed by detorsion on ovarian viability and histology: an ischaemia-reperfusion rodent model.Hum Reprod. 1998; 13: 2823-2827
- Laparoscopic resection of benign ovarian tumours in children with gonadal preservation.Pediatr Surg Int. 2009; 25: 251-254
- Ovarian bivalving after detorsion.Fertil Steril. 2002; 77: 1053-1055
- Conservative management of bilateral asynchronous adnexal torsion with necrosis in a prepubescent girl.J Pediatr Surg. 2000; 35: 1248-1251
- The effect of erythropoietin against oxidative damage associated with reperfusion following ovarian detorsion.Eur J Obstet Gynecol Reprod Biol. 2012; 162: 182-186
- Oophoropexy to prevent sequential or recurrent torsion.J Am Assoc Gynecol Laparosc. 1997; 4: 495-498
- Maximizing ovarian salvage when treating idiopathic adnexal torsion.J Pediatr Surg. 2000; 35: 624-626
- Ovarian torsion: to pex or not to pex? Case report and review of the literature.J Pediatr Adolesc Gynecol. 2003; 16: 381-384
This Clinical Practice Guideline has been prepared by the Canadian Paediatric and Adolescent Gynaecology and Obstetrics (CANPAGO) Committee; reviewed by the Clinical Practice-Gynaecology, Diagnostic Imaging, and Guideline Management and Oversight committees; and approved by the Board of the Society of Obstetricians and Gynaecologists of Canada.
Disclosure statements have been received from all principal authors.