Ovarian Torsion

Torsion may be complete, partial, or intermittent. Progressive venous and lymphatic obstruction precedes arterial compromise, producing edema and ovarian enlargement; preserved arterial flow therefore remains compatible with clinically important torsion.ScienceDirect+1ScienceDirectHigh risk and low prevalence diseases: Ovarian torsionWolters KluwerAdnexal Torsion in Adolescents : Obstetrics & Gynecology

Acute unilateral pelvic or lower abdominal pain with nausea or vomiting is the classic pattern, but pain may fluctuate, evolve over hours to days, or be less severe than expected. Torsion occurs across the age spectrum, including premenarchal patients, pregnancy, and postmenopause.Wolters Kluwer+2Wolters KluwerThe Elusive Diagnosis of Ovarian Torsion : Emergency Medicine NewsScienceDirectHigh risk and low prevalence diseases: Ovarian torsionWolters KluwerAdnexal Torsion in Adolescents : Obstetrics & Gynecology

An adnexal mass or cyst is a major risk factor, especially when larger than 5 cm; however, pediatric and adolescent torsion may involve a normal-appearing ovary without an associated mass in as many as 46% of cases.ScienceDirect+1ScienceDirectHigh risk and low prevalence diseases: Ovarian torsionWolters KluwerAdnexal Torsion in Adolescents : Obstetrics & Gynecology

Pelvic ultrasonography is the preferred initial imaging test in adolescents, generally transabdominal; assessment should include ovarian size and morphology, follicles, free fluid, vascular pedicle, and Doppler interrogation when feasible.Wolters KluwerWolters KluwerAdnexal Torsion in Adolescents : Obstetrics & Gynecology A systematic review cited in the supplied literature reports substantial variability in ultrasound sensitivity, reflecting operator and technical dependence.Nature+1NatureDual-modal photoacoustic and ultrasound imaging for early diagnosis of ovarian torsion and evaluation of long-term tissue hypoxia | Scientific ReportsWolters KluwerThe Elusive Diagnosis of Ovarian Torsion : Emergency Medicine News

Supportive sonographic findings include unilateral ovarian enlargement, stromal edema with peripheral follicles, free fluid, and a twisted vascular pedicle or whirlpool sign.Wolters KluwerWolters KluwerAdnexal Torsion in Adolescents : Obstetrics & Gynecology The whirlpool sign is highly specific when visualized but technically difficult to detect, particularly with transabdominal scanning.Wolters KluwerWolters KluwerAdnexal Torsion in Adolescents : Obstetrics & Gynecology

Color and spectral Doppler are adjuncts, not exclusion tests. In surgically confirmed torsion, normal Doppler arterial flow has been reported in up to 60% of cases; preserved flow may reflect intermittent torsion, partial torsion, collateral supply, or a torsed paratubal cyst.Wolters KluwerWolters KluwerAdnexal Torsion in Adolescents : Obstetrics & Gynecology

Adnexal torsion is a surgical diagnosis. When suspicion is clinically meaningful, timely diagnostic laparoscopy is indicated to preserve ovarian function and fertility, even though torsion may not be identified in a substantial fraction of explorations and alternative gynecologic pathology may be found and treated.Wolters KluwerWolters KluwerAdnexal Torsion in Adolescents : Obstetrics & Gynecology

Laparoscopy is the preferred operative approach in adolescents. The operative goal is detorsion and preservation of adnexal structures rather than resection based on color or perceived ischemia.Wolters KluwerWolters KluwerAdnexal Torsion in Adolescents : Obstetrics & Gynecology The gross blue-black appearance of an ovary is not a reliable marker of irreversible nonviability; ovarian function has been reported after detorsion despite ischemic appearance.Wolters KluwerWolters KluwerAdnexal Torsion in Adolescents : Obstetrics & Gynecology

Perform oophorectomy only when unavoidable, such as when the ovary is structurally non-salvageable and falls apart during surgery. The concern that detorsion causes embolic complications is unsupported in the ACOG guidance cited here.Wolters KluwerWolters KluwerAdnexal Torsion in Adolescents : Obstetrics & Gynecology

In adolescents, benign functional cysts and benign teratomas are common pathologies associated with torsion, whereas malignancy presenting as torsion is rare.Wolters KluwerWolters KluwerAdnexal Torsion in Adolescents : Obstetrics & Gynecology The possibility of malignancy should not be used as a default rationale for oophorectomy in this population.Wolters KluwerWolters KluwerAdnexal Torsion in Adolescents : Obstetrics & Gynecology

Diagnostic laparoscopy is appropriate when torsion is suspected despite uncertain imaging. A negative laparoscopy is considered an acceptable consequence of a fertility-preserving strategy, particularly because alternative gynecologic pathology is often identified.Wolters KluwerWolters KluwerAdnexal Torsion in Adolescents : Obstetrics & Gynecology

Photoacoustic-ultrasound imaging quantified tissue oxygen saturation in rat torsion models and detected progressive hypoxia during prolonged partial torsion; this is preclinical evidence, not a validated diagnostic or viability test in humans.NatureNatureDual-modal photoacoustic and ultrasound imaging for early diagnosis of ovarian torsion and evaluation of long-term tissue hypoxia | Scientific Reports

A retrospective Korean CT deep-learning study reported patient-level AUC of 0.80 for adnexal cystic torsion using a 3D EfficientNet model. The authors identified heterogeneous CT protocols, limited regional annotations, and lack of external validation as major limitations; the model should be considered investigational rather than a replacement for radiologist interpretation or clinical judgment.NatureNatureAdnexal torsion diagnosis framework with CT-based adaptive preprocessing and deep neural networks