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    Ovarian Torsion – Diagnosis and Treatment

    Obstetrics and Gynecology

    Last Updated Dec 29, 2022
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    First 5 Minutes

    • A high index of clinical suspicion is the most important factor in making the diagnosis of ovarian torsion in a timely manner to avoid ovarian ischemia (1)


    • Ovarian torsion involves partial or complete rotation of the ovarian vascular pedicle which causes obstruction to the venous and arterial flow, which can lead to ischemia of the ovaries if not treated in time (1,3).
    • Most common in females of reproductive age (mean of age of 30) but can occur at any age (1).
    • The most common risk factor is adnexal mass > 5 cm, but ovarian torsion cannot be ruled out in the absence of an ovarian mass or cyst (2,3).
    • Other risk factors include IVF, recent tubal ligation surgery, polycystic ovarian syndrome, and previous ovarian torsion (2,3).
    • The classic presentation of ovarian torsion is severe lower abdominal pain (90%) with nausea and vomiting (70%) (2,3). The presentation is variable, thereby, no single historical or physical examination finding should be used to rule in or rule out the diagnosis.

    Diagnostic Process

    • Ultrasound (transabdominal or transvaginal) is the first-line imaging modality for suspected ovarian torsion. Ultrasound can rule in ovarian torsion, but cannot rule out ovarian torsion as the sensitivity ranges from 35-85% (4).
    • Pelvic examination has poor sensitivity in detecting an ovarian mass or cyst, and the reliability of pelvic examinations is further reduced by obesity and age > 55 (5).
    • Diagnostic certainty can only be established from laparoscopic evaluation by a gynecologist (6).


    Recommended Treatment

    • The first-line treatment is laparoscopic adnexal detorsion (1,6).

    Criteria For Hospital Admission

    • Patients with suspected ovarian torsion are admitted to hospital. Gynecology should be consulted immediately whenever this diagnosis is suspected.

    Criteria For Transfer To Another Facility

    • Dependent on local guidelines. In general, transfer may be considered if:
    • Patient care requirements exceed hospital capabilities (e.g., cardiac monitoring, intensive care, maternal care, etc.).
    • Treatment is not available at current facility (no operating rooms).
    • Specialist consultations are required and not available at current facility.

    Criteria For Close Observation And/or Consult

    • Ovarian torsion is a time-sensitive diagnosis and warrants consultation with the obstetrics and gynecology service if there is suspicion of torsion based on history and examination (1)

    Criteria For Safe Discharge Home

    • Dependent on surgical outcome and clinical presentation.

    Quality Of Evidence?


    • Moderate quality. Prospective studies are limited in number and do not include randomized or blinded trials of treatment protocols. Much of the key literature is 10-15 years old.

    Related Information

    Reference List

    1. Nair S, Joy S, Nayar J. Five year retrospective case series of adnexal torsion. J Clin Diagn Res. 2014 Dec;8(12):OC09-13. doi: 10.7860/JCDR/2014/9464.5251.

    2. White M, Stella J. Ovarian torsion: 10-year perspective. Emerg Med Australas 2005;17:231–237

    3. Houry D, Abbott JT. Ovarian torsion: a fifteen-year review. Ann Emerg Med 2001;38:156–159.

    4. Swenson DW, Lourenco AP, Beaudoin FL, et al. Ovarian torsion: case-control study comparing the sensitivity and specificity of ultrasonography and computed tomography for diagnosis in the emergency department. Eur J Radiol 2014;83:733–738.

    5. Close RJ, Sachs CJ, Dyne PL. Reliability of bimanual pelvic examinations performed in emergency departments. West J Emerg Med 2001;175:240–244.

    6. Bar-On S, Mashiach R, Stockheim D, et al. Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate? Fertility and sterility 2010;93(6):2012-2015. DOI: https://doi.org/10.1016/j.fertnstert.2008.12.022


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