Ovarian Torsion: A Review of the Evidence

Abstract

Importance Ovarian torsion is a gynecological emergency caused by the twisting of the ovary and/or fallopian tube, further resulting in ischemic changes of the adnexa. Early diagnosis is likely to preserve ovarian function. Objective The purpose of this review is to review the current findings of ovarian torsion including clinical presentations, diagnostic criteria, surgical procedures, and prognosis. Evidence Acquisition The literature search is mainly available in PubMed and Web of Science platforms by searching “ovarian torsion” combined with one or several terms including “diagnosis” “risk factors” “surgery” and “torsion recurrence.” Results Abdominal pain, nausea, and vomiting were normal clinical presentations. In order to increase the accuracy of diagnosis, it is necessary to integrate clinical presentation and the findings of imaging and laboratory examinations. Computed tomography findings, plasma d-dimer level, and the time from pain onset play a critical role in distinguishing ovarian necrosis. The efficiency of oophoropexy on preventing recurrent ovarian torsion is controversial. Conclusion Most patients with early diagnosis of ovarian torsion may have a better prognosis with conservative surgery. Relevance Better understanding of ovarian torsion is critical for gynecologists to promote accuracy of diagnosis and select the optimal surgical procedure. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After completing this activity, the learner will be better able to explain clinical manifestations and findings of imaging; identify signs of ischemic necrosis in twisted ovaries; and discuss the optimal surgery for different populations of women with ovarian torsion.