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Management of Ovarian Torsion

Date of the Request: 26 April 2019

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1. Pediatric ovarian torsion: Follow- up after preservation of ovarian tissue

2. Conservative management of ovarian torsion in pre-pubertal girl

3. Ovarian cyst torsion in reproductive age group-changing trends in management

4. Laparoscopic Detorsion of Twisted Ovary in a Nulliparous Woman with a Recurrent, Bilateral

Mature Cystic Teratoma

5. Ovarian torsion in pediatric and adolescent patients: A systematic review

6. Apparent Gangrenous Twisted Ovarian Cyst in Adolescents: Successful Ovarian Conservation

Following Laparoscopic Detorsion

7. Conservative laparoscopic management of adnexal torsion based on a 17-year follow-up

experience

8. Ovarian torsion during third trimester of pregnancy: Laparoscopic management

9. Laparoscopic Adnexectomy for Ovarian Torsion during Late Pregnancy: Case Report of a Non-
Conservative Treatment and Literature Analysis.

10. Adnexal torsion: Management controversy: A case series

11. Evolution in the Management of Pediatric and Adolescent Ovarian Torsion as a Result of Quality
Improvement Measures

12. Impact of laparoscopic ovarian detorsion on ovarian reserve

13. Laparoscopic detorsion and successful pregnancy outcome following IVF pregnancy:

14. Laparoscopic detortion of twisted ovary in a nulliparous with a single ovary: Case report
15. Magnetic resonance imaging features of massive ovarian edema in pregnancy: utility for
decisions in expectant management.

16. Recurrent Ipsilateral Ovarian Torsion: Case Report and Literature Review.

17. Ultrasound-guided percutaneous aspiration of hyperreactio luteinalis avoids laparoscopic

untwisting of ovarian torsion

18. Detorsion of twisted haemorrhagic ovarian cyst

19. Ovarian torsion in children and adolescents: differential diagnosis of ovarian cysts

20. Case report: An alternative approach to acute ovarian torsion

21. To fix or not to fix: When should laparoscopic oophoropexy be undertaken in women with
recurrent ovarian torsion

22. Management of Isolated Tubal Torsion in a Premenarchal Adolescent Female with Prior
Oophoropexy: A Case Report and Review of the Literature

23. "Habitual Adnexal Torsions" -Recurrence after Two Oophoropexies in a Prepubertal Girl: A Case
Report and Review of the Literature

24. Torsion of the ovary in an incarcerated inguinal hernia

25. Laparoscopic management of a torted hyper stimulated ovary

26. Recurrence of ovarian torsion after bilateral synchronous torsion and oophoropexy: A case
report and review of the literature

27. Management of ovarian torsion in in vitro fertilization pregnancy

28. Laparoscopic management of twelve consecutive cases of ovarian torsion: Four years experience

29. Detorsion and conservative therapy for twisted adnexa: our experience.

30. Long-term results of conservative management of adnexal torsion in children.

31. Adnexal torsion in children may have a catastrophic sequel: asynchronous bilateral torsion.

32. Laparoscopic detorsion allows sparing of the twisted ischemic adnexa.

33. Long-term follow-up of the twisted ischemic adnexa managed by detorsion.

1. Pediatric ovarian torsion: Follow- up after preservation of ovarian tissue
Author(s): Geimanaite L.; Trainavicius K.
Source: Journal of Pediatric Surgery; 2019
Publication Date: 2019
Publication Type(s): Article
Abstract:Background: The aim of this study was to evaluate the efficiency of the preservation of
ovarian tissue in cases of ovarian torsion. Material(s) and Method(s): A retrospective study was
performed of patients treated at our hospital for ovarian torsion from January 2007 to December
2017. This research does not include patients with antenatal ovarian torsion and 1 girl with an
immature teratoma, in whom the twisted ovary was removed during the initial operation. Follow-up
ultrasonography of all patients was performed after 4-6 weeks and again after more than 12 weeks.
Volume, blood flow and folliculogenesis of the ovary were measured and assessed. Result(s): All 42
ovaries (39 patients) preserved their normal anatomy and folliculogenesis after detorsion. All
patients had an enlarged ovary at the time of detorsion. In all cases of ovarian torsion, enlargement
of the ovary up to an average of 58.14 +/- 52.86 (17.37-86.83) ml was detected. After 4-6 weeks, all
untwisted ovaries decreased in volume by an average of 9.01 +/- 13.69 (2.33-9.30) times, and 59.5%
of them became normal in size. In 3 girls, enlarged ovaries were still observed after 12 weeks.
Teratoma was diagnosed for these patients and ovarian sparing operations were performed.
Conclusion(s): It is safe to perform detorsion regardless of the level of ischemia or volume of the
affected ovary. The follow-up is essential, especially for the further diagnostics of potential
pathological structures or tumors; therefore, the normalization of blood flow and the volume of the
ovary must be monitored. Type of Study: Prognosis retrospective study. Level of Evidence:
IICopyright © 2019 Elsevier Inc.
Database: EMBASE

2. Conservative management of ovarian torsion in pre-pubertal girl

Author(s): Abdul Raheem T.; Gafar W.; Lloyd A.; Scarr C.
Source: European Journal of Obstetrics Gynecology and Reproductive Biology; Mar 2019; vol. 234
Publication Date: Mar 2019
Publication Type(s): Conference Abstract
Abstract:Introduction: Ovarian torsion, traditionally managed with oophorectomy, there is evidence
that a more conservative approach - detorsion/untwisting of the ovary - is an effective strategy. This
case involves a pre-pubertal girl. Objective(s): To increase awareness of the success rate of the
conservative management of ovarian torsion by untwisting the ovarian pedicle, regardless to the
degree of the ischemic changes of the ovary. Method(s): We reviewed existing evidence regarding
conservative management of ovarian torsion: * BMJ Best Practice (2015): "Laparoscopic surgery with
detorsion is the preferred treatment to preserve normal ovarian function and fertility" TOG 2012
Damigos et al. * Oeslner (1993): 40 patients with black/blue ischaemic adnexa managed by
untwisting. * Karayalcin et al (2011): Case series of 36 patients. * Fujishita et al (2015): Case series of
18 women. Discussion and conclusions: A 13 year old girl who presented to the ED with a 2-day
history of left-sided abdominal pain, backache and urinary symptoms. She was vitally stable and her
abdomen was soft, non-tender. She was discharged with oral antibiotics to treat a suspected UTI.
She was referred back the following day by her GP with worsening pain and vomiting. There was left
iliac fossa tenderness and left renal angle tenderness, however the abdomen was soft and not
peritonitic. Blood tests revealed a marginally raised CRP. A pelvic scan revealed an enlarged left
ovary with no blood flow and was highly suggestive of ovarian torsion. By this point she had been
symptomatic for over 5 days. A diagnostic laparoscopy revealed an enlarged necrotic left adnexa
that had twisted 3 times. Cyst aspiration and untwisting of the ovary was performed. Her symptoms
resolved postoperatively. A follow up scan 3 months later showed a normal-sized ovary with normal
blood flow. In conclusion, ovarian torsion is an important differential diagnosis to consider in girls
presenting with non-specific abdominal pain. Laparoscopic detorsion is an effective conservative
approach regardless to the degree of ischemic changes, that aims to preserve future
fertility.Copyright © 2018
Database: EMBASE

3. Ovarian cyst torsion in reproductive age group-changing trends in management

Author(s): Luthra A.
Source: International Journal of Gynecology and Obstetrics; Oct 2018; vol. 143 ; p. 334
Publication Date: Oct 2018
Publication Type(s): Conference Abstract
Available at International Journal of Gynecology and Obstetrics - from Wiley Online Library Science ,
Technology and Medicine Collection 2017
Abstract:Objectives: (1) Early diagnosis of ovarian cyst torsion by Ultrasound & Doppler study. (2)
Laparoscopic de-torsion and conservative surgery to preserve the ovary. Method(s): Design -
Retrospective study from 2013-2018. Setting - Advanced laparoscopy Centre. Patients - 23 patients
in reproductive age with acute abdominal pain and USG finding of ovarian cyst of 5 cm or more with
provisional diagnosis of twisted ovarian cyst were included. Inv - USG abdomen +TVS with Doppler,
MRI in cases suspicious of malignancy. Ovarian tumor markers. All patients were taken for
laparoscopy and assessed for characteristics of ovarian cyst, extent of torsion, detorsion of twisted
adnexa and reperfusion of tissue after untwisting. Post cystectomy ovarian function was assesed by
ovarian volume, follicles & doppler. Result(s): Detorsion of twisted ovarian/adenexal cyst results in
preservation of ovary and tube in 80% of cases. Conclusion(s): Early diagnosis and surgical
intervention is ideal in women with acute abdominal pain and suspected ovarian/adenexal torsion.
Laparoscopic DE torsion, conservation of healthy ovarian tissue helps in conserving the fertile
potential in young women. Risk of thromboembolism is rare in cases with twisted ovarian cysts.
Database: EMBASE

4. Laparoscopic Detorsion of Twisted Ovary in a Nulliparous Woman with a Recurrent, Bilateral

Mature Cystic Teratoma
Author(s): Rodrigues C.; Caldas R.; Reis I.; Kok M.; Lanhoso A.; Amaral J.
Source: Journal of Gynecologic Surgery; Oct 2018; vol. 34 (no. 5); p. 265-267
Publication Date: Oct 2018
Publication Type(s): Article
Abstract:Background: Ovarian mature cystic teratomas are common, benign, pelvic tumors easily
detected by ultrasonography. These tumors are bilateral in 8% to 15%, and recurrent teratomas are
uncommon and underdiagnosed. A benign dermoid cyst is the most common ovarian mass to
develop torsion. Although uncommon, adnexal torsions are an important cause of gynecological
emergencies. It was previously thought that untwisting the adnexa could result in an embolus from
thrombosed veins but this has proved untrue. Currently, it is considered that laparoscopic
conservative management by untwisting the ovary allows recovery of almost all cases, even when
the ovaries seem nonviable. Case: This article presents a case of an ovarian torsion in a 23-year-old
nulliparous woman referred to our emergency room because of acute right iliac fossa pain.
Ultrasound showed a complex right adnexal mass 60 x 60 mm. Three years earlier she had
undergone, in an urgent context, a left adnexectomy and a right cystectomy for bilateral teratoma
and torsion of the left ovary. We decided on a conservative laparoscopic approach with adnexal
detorsion. Result(s): At a follow-up visit, one year after the episode, the TVUS showed an ovary of
normal size and appearance. Conclusion(s): This case demonstrates the importance of conservative
treatment of adnexal torsion, especially in young women, allowing them to maintain their fertility.©
Copyright 2018, Mary Ann Liebert, Inc., publishers 2018.
Database: EMBASE

5. Ovarian torsion in pediatric and adolescent patients: A systematic review

Author(s): Dasgupta R.; Renaud E.; Goldin A.B.; Baird R.; Cameron D.B.; Arnold M.A.; Diefenbach
K.A.; Gosain A.; Jancelewicz T.; Williams R.F.; Grabowski J.; Guner Y.S.; Kawaguchi A.; Lal D.R.;
Oyetunji T.A.; Ricca R.L.; Shelton J.; Somme S.; Downard C.D.
Source: Journal of Pediatric Surgery; Jul 2018; vol. 53 (no. 7); p. 1387-1391
Publication Date: Jul 2018
Publication Type(s): Article
PubMedID: 29153467
Abstract:Objective: Ovarian torsion in pediatric patients is a rare event and is primarily managed by
pediatric general surgeons. Torsion can be treated with detorsion of the ovary or oopherectomy.
Oopherectomy is the most common procedure performed by pediatric general surgeons for ovarian
torsion. The purpose of this systematic review by the American Pediatric Surgical Association
Outcomes and Evidence Based Practice Committee was to examine evidence from the medical
literature and provide recommendations regarding the optimal treatment of ovarian torsion.
Method(s): Using PRISMA guidelines, six questions were addressed by searching Medline, Cochrane,
Embase Central and National clearing house databases using relevant search terms. Risks of ovarian
detorsion including thromboembolism and malignancy, indications for oophoropexy, benefits of
detorsion including recovery of function and subsequent fertility, and recommended surveillance
after detorsion were evaluated. Consensus recommendations were derived for each question based
on the best available evidence. Result(s): Ninety-six studies were included. Risks of ovarian detorsion
such as thromboembolism and malignancy were reviewed, demonstrating minimal evidence for
unknowingly leaving a malignancy behind in the salvaged ovary and no evidence in the literature of
thromboembolic events after detorsion of a torsed ovary. There is no clear evidence supporting the
benefit of oophoropexy after a single episode of ovarian torsion. The gross appearance of the ovary
does not correlate with long-term ovarian viability or function. Pregnancies have occurred in
patients after detorsion of an ovary both spontaneously and with harvested oocytes from previously
torsed ovaries. The consensus recommendation for imaging surveillance following ovarian detorsion
is an ultrasound at 3 months postprocedure but sooner if there is a concern for malignancy.
Conclusion(s): There appears to be overwhelming evidence supporting ovarian detorsion rather than
oopherectomy for the management of ovarian torsion in pediatric patients. Ovarian salvage is safe
and is the preferred treatment for ovarian torsion. Most salvaged ovaries will maintain viability after
detorsion. Type of Study: Systematic review of level 3-4 studies. Level of Evidence: 3-4Copyright ©
2017 Elsevier Inc.
Database: EMBASE

6. Apparent Gangrenous Twisted Ovarian Cyst in Adolescents: Successful Ovarian Conservation

Following Laparoscopic Detorsion
Author(s): Yong S.L.; Mohd Basir M.H.; Wong S.I.L.; Ong Z.W.; Kang M.
Source: Journal of Gynecologic Surgery; Jun 2018; vol. 34 (no. 3); p. 150-153
Publication Date: Jun 2018
Publication Type(s): Article
Abstract:Background: Ovarian torsion is a rare gynecologic emergency in adolescents and, upon
diagnosis, immediate surgical intervention is mandatory to salvage the affected ovary.
Oophorectomy is conventionally performed when the affected ovary is clinically deemed nonviable.
However, a recent conservative method of detorsion and conservation of an apparently gangrenous
twisted ovarian cyst has emerged, and it has been proven that seemingly gangrenous ovarian tissue
is still capable of remaining viable even after prolonged ischemia. Cases: This article reports 2 cases
of young adolescents, each of whom presented with an acute abdomen secondary to ovarian cyst
torsion. Both patients were managed with two-stage conservative laparoscopic surgery
(laparoscopic detorsion followed by interval laparoscopic cystectomy) performed by a general
gynecologist in a district hospital. Although the twisted ovary appeared gangrenous during the
emergency diagnostic laparoscopy in both cases, detorsion rather than conventional oophorectomy
was performed. Results: In each case, subsequent second-look laparoscopy revealed viable ovarian
tissue, enabling conservation of the ovary by only cystectomy, thus salvaging a previously apparent
gangrenous ovary. Histopathologic testing confirmed benign ovarian cysts in both cases.
Conclusions: Laparoscopic detorsion is currently the preferred choice of treatment for a twisted
ovary in an adolescent, despite its gangrenous appearance. This is a simple but crucial procedure
that can be performed easily by a general gynecologist with level 2 operative laparoscopic skills.
Detorsion would be a superior option to maximize female ovarian reserve and future reproductive
potential. (J GYNECOL SURG 34:150)© Copyright 2018, Mary Ann Liebert, Inc.
Database: EMBASE

7. Conservative laparoscopic management of adnexal torsion based on a 17-year follow-up

experience
Author(s): Chu K.; Zhang Q.; Sun N.; Ding H.; Li W.
Source: Journal of International Medical Research; Apr 2018; vol. 46 (no. 4); p. 1685-1689
Publication Date: Apr 2018
Publication Type(s): Article
PubMedID: 29486636
Available at Journal of International Medical Research - from Free Medical Journals . com
Available at Journal of International Medical Research - from Unpaywall
Abstract:Laparoscopic unwinding of adnexal torsion has been proposed for decades. However, this
technique is still controversial regarding the concern of thromboembolic events. We present two
cases of conservative laparoscopic management of adnexal torsion. In the first case, a 16-year-old
adolescent with serous cystadenoma was successfully managed by untwisting and cystectomy. We
followed up this patient for 17 years with regular re-examinations in our hospital. To the best of our
knowledge, this is the longest follow-up reported of this condition. In the second case, a 32-year-old
infertile woman who received oocyte retrieval 3 days before being admitted to hospital was referred
to hospital with right ovarian torsion. We treated her successfully based on our long-term follow-up
experience, and she is now asymptomatic and in her 7th month of pregnancy.Copyright © 2018, ©
The Author(s) 2018.
Database: EMBASE
8. Ovarian torsion during third trimester of pregnancy: Laparoscopic management
Author(s): Heredia F.M.; Bustos A.; Stecher J.F.; Hinostroza M.; Escalona J.R.; Donetch G.R.
Source: Journal of Minimally Invasive Gynecology; 2017; vol. 24 (no. 7)
Publication Date: 2017
Publication Type(s): Conference Abstract
Abstract:This video shows a rare case of ovarian torsion during 33rd week of gestation managed
laparoscopically. An open 10 mmHg pneumoperitoneum was performed in the subxyphoid area.
Three auxiliary ports were placed after tilting the operation table to the left. Careful untwisting of
the uteroovaric pedicle followed by an inbag cyst aspiration and then cystectomy were done with
minimal bipolar coagulation of the tumoral bed. Biopsy proved a benign serous cystoadenoma. Baby
was delivered uneventfully at 39 weeks, 6 weeks after this surgery was performed. The purpose of
this video is to demonstrate feasibility of a simple, safe and reproductible technique which requires
basic training and instruments widely available.
Database: EMBASE

9. Laparoscopic Adnexectomy for Ovarian Torsion during Late Pregnancy: Case Report of a Non-
Conservative Treatment and Literature Analysis.
Author(s): Bouquet de Joliniere, Jean; Dubuisson, J B; Khomsi, F; Fadhlaoui, A; Grant, G; Ali, N Ben;
Major, A; Feki, A
Source: Frontiers in surgery; 2017; vol. 4 ; p. 50
Publication Date: 2017
Publication Type(s): Case Reports
PubMedID: 29075630
Available at Frontiers in surgery - from Europe PubMed Central - Open Access
Available at Frontiers in surgery - from Unpaywall
Abstract:Diagnosis of adnexial torsion is difficult during pregancy (1). The time of decision and
laparoscopy is that of the risk of necrosis of the adnexa and, therefore, of the ovarian prognosis. The
loss of an ovary can compromise the following fertility. Even if concerns related to laparoscopy in
pregnant patients include a limited surgical field, with a risk of uterine injury and negative fetal
effects of CO2 insufflation. Evidence base suggests that minimally invasive surgery can be safe and
better than laparotomy for management of adnexal masses during late pregnancy with good
postoperative and obstetric outcomes. If for most authors laparoscopy appears to become the best
approach for ovarian torsion during pregnancy (2), nonetheless, the ideal surgical laparoscopic
approach of adnexa in late pregnancy remains controversial. Since there is no technical gold
standard to overcome surgical difficulties which could make laparoscopic procedures as real
challenge in patients in second and third trimester (3); at least, in case of radical and non-
conservative treatment, the risk for a first trimester of pregnancy is to remove the corpus luteum
(1).
Database: Medline

10. Adnexal torsion: Management controversy: A case series

Author(s): Moiety F.M.S.
Source: Middle East Fertility Society Journal; Jun 2017; vol. 22 (no. 2); p. 156-159
Publication Date: Jun 2017
Publication Type(s): Article
Available at Middle East Fertility Society Journal - from Unpaywall
Abstract:Objective To present and analyse a case series with adnexal torsion, and to describe
management options applied. Study design A prospective analysis, over 4 years; (October 2011 to
October 2015). Setting University hospital's Gynaecology centre. Subjects & methodology A total of
46 patients presenting with adnexal torsion were analysed, 22 of which were pregnant. Intervention
Laparoscopy was done for all cases, and decision for detorsion, Ovarian cystectomy, or adnexectomy
was taken immediately. Main outcome measures Ovarian structure and function conservation, in
terms of restoration of normal ovarian blood flow, proven by color Doppler Ultrasonographic scan,
after 1, 6 and 12 months, normal ovarian volume and follicular development, by Ultrasound scan at
1, 6 and 12 months, second look laparoscopy, recommended for the non-pregnant group, showing a
normal appearance, size, and position of the ovaries, and the gross appearance of the ovaries for the
pregnant who underwent a Cesarean section (CS). Results Ovarian torsion was diagnosed in 48
ovaries (2 bilateral), All of the cases were managed by detorsion, with cystectomy (if ovarian cyst
present), with or without oophoropexy. Adnexectomy was not done in any case. No complication,
nor conversion to laparotomy was reported. 2 cases showed recurrence (4.43%) one pregnant, at 34
weeks, and was managed by a Caesarean section and detorsion, and one non-pregnant, managed by
a second laparoscopic detorsion. Follow up by Ultrasonographic, and color Doppler scans, second
look laparoscopy (done in 16/24 cases), and inspection at CS, proved complete conservation of the
treated ovaries. Conclusions Laparoscopic management of ovarian torsion - whether in pregnancy or
not- seems to be the route of choice. Detorsion was adequate to preserve ovarian structure and
function in all cases studied, regardless of the degree of ovarian ischemia, the surgeon found.
Ovarian fixation after detorsion was not found to be necessary to decrease recurrence.Copyright ©
2017 Middle East Fertility Society
Database: EMBASE

11. Evolution in the Management of Pediatric and Adolescent Ovarian Torsion as a Result of
Quality Improvement Measures
Author(s): Hubner N.; Kives S.; Allen L.M.; Langer J.C.
Source: Journal of Pediatric and Adolescent Gynecology; Feb 2017; vol. 30 (no. 1); p. 132-137
Publication Date: Feb 2017
Publication Type(s): Conference Paper
PubMedID: 27381235
Abstract:Study Objective The aim of this study was to document the change in ovarian conservation
rate after ovarian torsion as a result of continuous quality improvement (CQI) measures, and to
determine factors that contribute to this outcome. Design A retrospective, uncontrolled before-and-
after study. Setting An academic children's hospital. Participants Female adolescents younger than
18 years with surgically confirmed ovarian torsion from April 1, 1988 to October 15, 2013; excluding
cases from 2003 (intervention period). Interventions Implementation of CQI measures including
educational programs, collaborative care pathways, and quality review with the goal of improving
ovarian conservation. Main Outcome Measures Demographic characteristics, details on
presentation, investigations, consultation, surgical intervention, surgical findings, pathology,
postoperative course, and follow-up imaging. Results One hundred thirty-nine patients met inclusion
criteria (42 pre-CQI cohort and 97 post-CQI cohort). Mean ages were 9.96 and 10.33 years,
respectively. Ovarian conservation rates were 47.6% compared with 85.6%, respectively (P < .001).
The following factors differed between cohorts: fever (P = .003), ultrasound completed (P = .001),
time from first health care provider visit to imaging (P = .025), time from specialist consultation to
surgery (P = .002), surgical start time within 1 hour of booking (P < .001), and gynecologist present in
operating room (P < .001). A log-binomial regression model showed that gynecology presence in the
operating room (relative risk [RR], 2.043) was associated with untwisting. Increasing time from
specialist consultation to surgery (RR, 0.986 per hour) was inversely associated with untwisting.
Fever at presentation was also inversely associated with untwisting (RR, 0.666). Conclusion The
implementation of CQI measures was associated with a significant increase in ovarian conservation
rate.Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology
Database: EMBASE

12. Impact of laparoscopic ovarian detorsion on ovarian reserve

Author(s): Yasa C.; Dural O.; Bastu E.; Zorlu M.; Demir O.; Ugurlucan F.G.
Source: Journal of Obstetrics and Gynaecology Research; Feb 2017; vol. 43 (no. 2); p. 298-302
Publication Date: Feb 2017
Publication Type(s): Article
PubMedID: 27928855
Available at Journal of Obstetrics and Gynaecology Research - from Wiley Online Library Science ,
Technology and Medicine Collection 2017
Abstract:Aim: The aim of this study was to evaluate ovarian reserve after laparoscopic ovarian
detorsion in patients with ovarian torsion. Methods: From February 2014 to September 2015, a total
of 11 patients with ovarian torsion underwent laparoscopic detorsion. These 11 patients were
eligible for study, and ovarian reserve was assessed on serum anti-Mullerian hormone (AMH) and by
antral follicle count preoperatively, and in postoperative months 1 and 3. Results: Mean patient age
was 25.4 +/- 5.5 years. Although mean antral follicle count on the operated side was slightly lower
than on the contralateral side at 1 month postoperatively (P > 0.05), at 3 months postoperatively
there was no difference in mean antral follicle count between the operated and contralateral sides
(P > 0.05). There was no significant change in serum AMH level at 1 and 3 months postoperatively
compared with the preoperative level (P > 0.05). Conclusions: Laparoscopic detorsion of twisted
ovary is a safe procedure to preserve ovarian function, and does not impair ovarian reserve
according to antral follicle count and AMH during the course of follow-up.Copyright © 2016 Japan
Society of Obstetrics and Gynecology
Database: EMBASE

13. Laparoscopic detorsion and successful pregnancy outcome following IVF pregnancy:
Author(s): Agrawal N.; Al-Inizi S.
Source: Human Fertility; 2016; vol. 19 (no. 1)
Publication Date: 2016
Publication Type(s): Conference Abstract
Abstract:Objective: Ovarian stimulation increases the risk of ovarian torsion. Early clinical diagnosis
and laparoscopic detorsion would able to preserve torsed adenexa. Doppler ultrasound is an
important investigation to check vascular flow. Case report: A 31 year old lady underwent IVF for
secondary tubal and sperm sub fertility. She attended A&E with 2 days history of severe right sided
abdominal pain one week following embryo transfer. She was managed conservatively with
analgesia hydration and VTE prophylaxis with D/D of OHSS. Ultrasound revealed enlarged right
multicystic ovary with normal arterial and venous flow. She underwent laparoscopic untwisting of
right adenexa and multiple ovarian cyst drainage for uncontrolled pain and suspected diagnosis of
ovarian torsion. Right ovary was enlarged to 16-18 cm with torted right cyst 3 times and evidence of
1.5 lit ascitis. She had serial growth scans at 32 and 36 weeks which showed normal growth. She
came into spontaneous labour at 40+5 & had emergency CS category 1 for presumed fetal
compromise at 9 cm dilatation with fetal maternal tachycardia and suspected chorioamnionitis.
Right ovary was found to be enlarged intraoperatively. Discussion(s): Laparoscopic surgery is safe in
first and second trimester. Therefore an ovarian torsion should be treated by minimal invasive
surgery. Maternal adenexal torsion is very rare in spontaneous pregnancies. Since it has been
described as a severe complication after controlled ovarian hyper-stimulation for IVF, it is more
common in IVF pregnancies. Sequential and repeated ovarian torsion have been reported. Doppler
ultrasound should be considered as a first line exam. The complete absence of vascular flow may be
an indication for adenexectomy. Conclusion(s): Clinicians should be aware of D/D of ovarian torsion
following IVF pregnancy. Early clinical diagnosis supported by scan would help to preserve the
twisted adenexae.
Database: EMBASE

14. Laparoscopic detortion of twisted ovary in a nulliparous with a single ovary: Case report
Author(s): Santos F.; Rodrigues C.; Amaral J.; Foo M.; Lanhoso A.
Source: Gynecological Surgery; 2016; vol. 13 (no. 1)
Publication Date: 2016
Publication Type(s): Conference Abstract
Available at Gynecological Surgery - from SpringerLink
Available at Gynecological Surgery - from ProQuest (Health Research Premium) - NHS Version
Abstract:Background Adnexal torsion is an uncommon but important cause of gynecological
emergency. The annual prevalence is approximately 2% to 6%. Torsion generally occurs in women
with moderately enlarged ovaries, often in association with an ovarian cyst. It was previously
thought that untwisting the adnexa could result in an embolus from thrombosed veins but this has
been proved untrue. Recent studies showed that laparoscopic conservative management with
untwisting the ovary allows the recovery of almost all the cases, even macroscopically non-viable
ovaries. In this way, our main objective is to present a case of ovarian torsion in a 23-year old
nulliparous woman with a single ovary. Methods The case is presented with appropriate history,
laboratory values, imaging results and treatment description. Literature of the topic of conservative
approach of adnexal torsion is systematically reviewed. Results A 23-year-old nulliparous woman,
presented to the emergency unit with a 2 days history of right iliac fossa pain. She had history of left
oophorectomy and right cystectomy 3 years ago due to dermoid cyst. Transvaginal ultrasound shows
a right adnexal mass of 60x60mm with a small amount of free fluid in the pouch of Douglas. On the
2nd day of admission, a diagnostic laparoscopy was performed which confirmed a 7cm dark,
hemorrhagic, edematous twisted right ovary. The right ovary was untwisted and after several (30)
minutes the normal coloration of this structure was reestablished. The surgeons performed
ovariopexy to the posterior wall of the uterus. In a second-look laparoscopy, performed 6 weeks
after the acute episode, a right ovarian mass with appearance consistent with a dermoid cyst was
detected and cystectomy was done. After surgery the patient has been followed-up with abnormal
clinically symptoms of menopause, ultrasound and basal FSH plus estradiol. Conclusions There are
conservative and definitive options for treatment. The factors involved in this decision include age,
future fertility, menopausal status and evidence of ovarian disease. In this particular case, of a
nulliparous with a single ovary, an attempt to preserve ovary function and subsequent fertility was
mandatory. Even if the ovary appears dark and dusky on initial inspection most ovaries (90%)
demonstrate normal follicular development on ultrasound and normal gross appearance on second
look surgery. The difficulty of performing cystectomy at the time of detorsion is the loss of tissue
plans which may result in excision of undue amount of ovarian tissue. Perform a cystectomy as an
elective procedure allowed, optimize the intervention and verify the appearance of the ovary few
weeks after detorsion.
Database: EMBASE

15. Magnetic resonance imaging features of massive ovarian edema in pregnancy: utility for
decisions in expectant management.
Author(s): Gobara, Aiko; Yoshizako, Takeshi; Yoshida, Rika; Okada, Naruhito; Makihara, Ken;
Kitagaki, Hajime
Source: SpringerPlus; 2016; vol. 5 (no. 1); p. 1444
Publication Date: 2016
Publication Type(s): Journal Article
PubMedID: 27652020
Available at SpringerPlus - from Europe PubMed Central - Open Access
Available at SpringerPlus - from Unpaywall
Abstract:INTRODUCTIONMassive ovarian edema (MOE) is a rare disease and few reports have
described the magnetic resonance (MR) imaging manifestations in pregnancy.CASE DESCRIPTIONWe
report here a case of MOE in a patient at 12 weeks' gestation. Abdominal T2-weighted MR images
showed asymmetric ovarian enlargement in a teardrop configuration, hyperintense peripherally
displaced follicles, and twisting of the vascular pedicle between the enlarged ovary and uterus. The
diagnosis of MOE due to ovarian torsion was confirmed by exploratory laparotomy. Preoperative
imaging, especially the MR imaging could distinguish MOE from other conditions and demonstrate
the relations of adjunct organ, and allowed for untwisting during laparotomy with successful
preservation of the ovary.DISCUSSION AND EVALUATIONUltrasonography is important in detecting,
evaluating, and determining the malignant potential of adnexal masses in pregnancy, but its findings
may be nonspecific and then MR may assist characterization. This case was tentatively diagnosed as
typical MOE by preoperative imaging, but the shape and location of the hugely enlarged ovarian
mass suggested torsion of the ovarian pedicle. In our case, the diagnosis was confirmed by
exploratory laparotomy and the pedicle was successfully untwisted.CONCLUSIONMR imaging proved
useful for decisions on expectant management of MOE in pregnancy, and the patient's affected
ovary could be preserved.
Database: Medline

16. Recurrent Ipsilateral Ovarian Torsion: Case Report and Literature Review.
Author(s): Bertozzi, Mirko; Magrini, Elisa; Bellucci, Cristina; Riccioni, Sara; Appignani, Antonino
Source: Journal of pediatric and adolescent gynecology; Dec 2015; vol. 28 (no. 6); p. e197
Publication Date: Dec 2015
Publication Type(s): Case Reports Journal Article Review
PubMedID: 26099697
Abstract:BACKGROUNDRecurrent ipsilateral ovarian torsion at pediatric age is a rare event. Different
surgical techniques for its prevention are available. We present a case of recurrent ipsilateral ovarian
torsion in a prepubertal girl and we reviewed the literature about the management of this
condition.CASEA 6-year-old girl presented with right ovarian torsion and underwent a laparoscopic
untwisting. Nine months later an ipsilateral recurrence occurred. Laparoscopic untwisting and right-
sided oophoropexy with plication to the round ligament was performed.SUMMARY AND
CONCLUSIONIn addition to our presented case, four cases of recurrent ipsilateral ovarian torsion in
pediatric patients were identified in the literature. The few available reports in the pediatric
literature show different management techniques. A long-term study is necessary to define the most
effective treatment.
Database: Medline

17. Ultrasound-guided percutaneous aspiration of hyperreactio luteinalis avoids laparoscopic

untwisting of ovarian torsion
Author(s): Sakae C.; Sato Y.; Taga A.; Satake Y.; Emoto I.; Maruyama S.; Kim T.
Source: Ultrasound in obstetrics & gynecology : the official journal of the International Society of
Ultrasound in Obstetrics and Gynecology; Aug 2015; vol. 46 (no. 2); p. 243-246
Publication Date: Aug 2015
Publication Type(s): Article
PubMedID: 25810122
Available at Ultrasound in obstetrics & gynecology : the official journal of the International Society
of Ultrasound in Obstetrics and Gynecology - from Wiley Online Library Science , Technology and
Medicine Collection 2017
Available at Ultrasound in obstetrics & gynecology : the official journal of the International Society
of Ultrasound in Obstetrics and Gynecology - from Unpaywall
Abstract:Hyperreactio luteinalis (HL) is characterized by multicystic bilateral enlargement of the
ovaries and is a self-limiting benign condition associated with pregnancy or trophoblastic disease.
Since HL regresses spontaneously over time, it should be managed conservatively as long as the
patient's condition permits; torsion of the enlarged ovaries is believed to be the only exception that
mandates surgical intervention. Here, we describe a case of HL complicated by ovarian torsion that
was treated successfully without surgical intervention. A 33-year-old woman was admitted to our
hospital owing to acute abdomen. Nine days previously, she had had a stillbirth caused by hydrops
fetalis at 24 weeks' gestation. The characteristic findings observed on magnetic resonance imaging
(MRI) led to the diagnosis of HL complicated by torsion of the enlarged left ovary. Emergency
laparoscopic detorsion of the ischemic left ovary was planned. Aiming to reduce the risk of cystic
injury and bleeding at the trocar insertion site, volume reduction of the left ovarian cyst was
performed by percutaneous aspiration. The patient's pain diminished rapidly and laparoscopic
surgery was deferred. Subsequent MRI revealed that gadolinium enhancement of the left ovarian
tumor had been restored, indicating spontaneous detorsion of the left ovary. The patient remained
asymptomatic and was discharged from the hospital 12 days after aspiration of the cyst. From this
experience, we propose that, in cases of ovarian torsion occurring in large functional cysts, including
HL, volume reduction by percutaneous cyst aspiration should be considered before performing
emergency laparoscopic surgery.Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Database: EMBASE

18. Detorsion of twisted haemorrhagic ovarian cyst

Author(s): Anwar S.
Source: BJOG: An International Journal of Obstetrics and Gynaecology; Apr 2015; vol. 122 ; p. 68
Publication Date: Apr 2015
Publication Type(s): Conference Abstract
Available at BJOG: An International Journal of Obstetrics and Gynaecology - from Wiley Online
Library Science , Technology and Medicine Collection 2017
Available at BJOG: An International Journal of Obstetrics and Gynaecology - from Unpaywall
Abstract:Introduction Ovarian torsion is the fifth most common gynaecological surgical emergency
accounting for 2.7% of acute gynaecological cases. Two groups of women are affected by ovarian
torsion women in mid 20s and women who are postmenopausal. Approximately 17% cases have
been found in premenarchal and postmenopausal women. The recurrence rate is 19.5% in pregnant
and 9.1% in nonpregnant women. The ovarian salvage rate has been reported around 10% in adults
and 27% in a study among the paediatric group. The traditional recommended treatment for ovarian
torsion is the removal of the ovary without detorsion. However, conservative approach should be
taken as most of the women with adnexal torsion are of reproductive age. Our case is about a young
female presented with ovarian torsion and was managed conservatively. Case A 24-year-old female
with right sided lower abdominal pain and recent episode of vomiting presented to ER. She had
typical features of PCO. The beta-hCG was negative. She was seen by the surgeons and diagnosed as
acute appendix. Her WBC count was 12 000. She had laparoscopic appendectomy. After
appendectomy they found a large 4-5 times twisted haemorrhagic ovarian cyst about 9 x 8 cm
impacted in POD. Laparotomy was performed and ovarian tissue that was very fragile and dark
coloured was distorted and warm packs applied for 15-20 min. The blackish, brown colour changed
to pinkish coloration of healthy ovarian tissue, oedema and size decreased to 7 x 6 cm. The other
adnexa and uterus was normal. The patient had uneventful recovery. The scan at 4 weeks showed
normal right adnexa with normal Doppler studies. The patient was prescribed OCPs to avoid further
cyst formation and to regulate her cycle. Conclusion At present the standard option to treat twisted
ischaemic adnexa is adnexatomy without untwisting. The risk of thromboembolism was thought to
be so high that oophorectomy was done for all patients regardless of age. Wagman and Williams, in
a literature review, found no cases of pulmonary embolism occurring from detorsion. In our opinion
even the gangrenous appearing adnexa should not be removed as just by untwisting and applying
warm sponges the colour changed dramatically to normal. Every gynaecologist and paediatric
surgeon should be aware of this novel option of preserving the child bearing function as an
alternative of removal of ovaries in a young female patient.
Database: EMBASE

19. Ovarian torsion in children and adolescents: differential diagnosis of ovarian cysts
Author(s): Evrard A.; Nisolle M.
Source: Gynecological Surgery; Sep 2014; vol. 11 (no. 1); p. 336-337
Publication Date: Sep 2014
Publication Type(s): Conference Abstract
Available at Gynecological Surgery - from SpringerLink
Available at Gynecological Surgery - from ProQuest (Health Research Premium) - NHS Version
Available at Gynecological Surgery - from Unpaywall
Abstract:Objectives Introduction: Ovarian cysts are frequent conditions in the paediatric age group.
They are characterized by different clinical presentations and by the need to establish adequate type
and timing of treatment in order to prevent complications such as ovarian necrosis resulting from
torsion and secondary infertility. A differential diagnosis has to be established between benign
follicular cysts and neoplastic lesions or organic cysts. Methods Case report: A 12 years-old girl was
admitted at the hospital with an acute abdomen presentation (pelvic pain, nausea and vomiting)
associated with hyperthermia and leucocytosis, which could suggest an acute appendicitis. The
measurement of -hCG was negative. Ultrasound examination demonstrated a 9 cm left ovarian cyst
with a heterogeneous content, normal flow and fluid collection in Douglas. A laparoscopy was
performed in emergency. The diagnosis of ovarian torsion on a haemorrhagic corpus luteum cyst
was confirmed and, after untwisting left ovary, a partial cystectomy was performed. Results
Discussion: There are different group of ovarian cysts: functional cysts (follicular or corpus luteum
cysts) and organic cysts. Ovarian tumours are uncommon in children. 2/3 is benign and germinal
tumours are the most frequent. Mature teratomas are present in 90% of cases. Malignant tumours
(malignant germ cell tumours 85%) represent only 1% of all paediatrics malignancy. Other diagnosis
must be eliminated: appendiceal abscess, hydrosalpinx, extra-uterine pregnancy or uterine
malformation. Conclusions Conclusions: The surgical treatment of children and adolescents
presenting annexe torsion should be practiced as an emergency and it should be more conservative
as possible in order to preserve the future reproductive potential. The essential objective aims to
not ignore an ovarian torsion, an organic cyst or a malignancy, which all need chirurgical
intervention, without operating a benign follicular cyst unnecessarily.
Database: EMBASE

20. Case report: An alternative approach to acute ovarian torsion

Author(s): Langley C.; Rahman S.; Moncreiffe L.; Tuck J.; Jayaram P.
Source: Gynecological Surgery; Sep 2014; vol. 11 (no. 1); p. 319-320
Publication Date: Sep 2014
Publication Type(s): Conference Abstract
Available at Gynecological Surgery - from SpringerLink
Available at Gynecological Surgery - from ProQuest (Health Research Premium) - NHS Version
Available at Gynecological Surgery - from Unpaywall
Abstract:Objectives This case report describes a woman of reproductive age with acute ovarian
torsion who was managed with conservative surgery, in support of the growing body of evidence for
less invasive surgical management of this condition. Our aims are to show that expert and timely
radiological input can assist in the diagnosis of ovarian torsion, and that less invasive surgical
management can be a successful and beneficial option for women with this condition. Methods Case
report of acute ovarian torsion managed with laparoscopic untwisting of the affected ovary and
comparison with similar case report outcomes. Results A 27-year-old woman, with a history of
Polycystic Ovarian Syndrome, presented with a three day history of worsening left iliac fossa pain
and vomiting. On admission she had a mild neutrophilia. Trans-vaginal ultrasound with colour-flow
Doppler revealed a grossly enlarged left ovary, with reduced vascularity. Her clinical condition
subsequently deteriorated, and an urgent diagnostic laparoscopy was performed. At laparoscopy a
long left ovarian pedicle was noted, which had twisted three times. The left ovary was enlarged,
congested and oedematous. No other pelvic pathology was identified. The left adnexa was
untwisted resulting in restoration of blood flow - subsequently the ovary and fallopian tube
appeared less congested. The patient was asymptomatic and discharged 24 hours later. Follow-up
ultrasound four weeks later revealed a healthy, normal looking left ovary. Conclusions Ovarian
torsion remains a relatively rare but potentially serious gynaecological emergency, with
complications that include ovarian ischaemia, infection, peritonitis, pelvic adhesions and chronic
pelvic pain. Traditionally the condition has been treated by oophorectomy of the affected ovary,
with or without salpingectomy. This operation is more recently being challenged in favour of more
conservative management options, such as ovarian/adnexal de-torsion with or without
oophoropexy, that allow preservation of the ovary and its function. Delay in surgical correction of
the torted ovary is thought to increase the likelihood of adnexal ischaemia, with an inverse
relationship between duration of symptoms and ovarian viability. Evidence is now emerging that
even the grossly ischaemic-looking ovary at laparoscopy will re-gain some perfusion when un-
twisted. This case supports the growing evidence for less invasive management of acute ovarian
torsion, particularly in young women of reproductive age. It supports the use of imaging by
experienced radiologists using colour-flow Doppler to allow for timely diagnosis. One of the main
diagnostic dilemmas is lack of consensus for imaging and clinical criteria to diagnose ovarian torsion,
as history, examination and investigation findings can be vague and non-specific. Multi-disciplinary
management with expert radiological input can help to delegate these patients to appropriate
laparoscopic specialists, allowing for possibly less invasive surgical options.
Database: EMBASE

21. To fix or not to fix: When should laparoscopic oophoropexy be undertaken in women with
recurrent ovarian torsion
Author(s): Akhtar M.; Hartley J.; Anand S.; Edi-Osagie E.
Source: Gynecological Surgery; Sep 2014; vol. 11 (no. 1); p. 199-200
Publication Date: Sep 2014
Publication Type(s): Conference Abstract
Available at Gynecological Surgery - from SpringerLink
Available at Gynecological Surgery - from ProQuest (Health Research Premium) - NHS Version
Available at Gynecological Surgery - from Unpaywall
Abstract:Objectives To investigate and recommend when laparoscopic Oophoropexy (fixation of the
ovary to a pelvic anchor) should be undertaken in women with recurrent ovarian torsion. Prompt
diagnosis of ovarian torsion enables ovarian conservation but this introduces increased risks of
further torsion as ovaries that have undergone torsion have increased risks of recurrent torsion.
There is a lack of consensus on how to manage this increased risk of recurrent torsion. Methods
Case study and review of relevant literature. The index case was a 28-year-old nulliparous woman
presenting with acute pelvic pain due to her third episode of right ovarian torsion presumably
predisposed to by large polycystic ovaries. She had presented twice before with right sided lower
pelvic pain and found to have right ovarian torsion on laparoscopy and so had undergone two
previous episodes of laparoscopic untwisting of the ovaries without Oophoropexy (as no other
ovarian pathology was found) in 2012 and 2013. During the index admission, she presented with
similar right sided lower pelvic pain. Pelvic ultrasound suggested a 3x4cm right adnexal mass. The
severity of her pain prompted emergency diagnostic laparoscopy. Medline entries from 1992 were
searched with the MESH terms 'ovarian torsion' and 'Oophoropexy' and relevant articles included in
the review. Results The index laparoscopy demonstrated torsion involving the right ovary and
fallopian tube both of which still appeared viable with no other adnexal/pelvic pathology. The
decision was taken to perform untwisting of the right adnexal torsion as well as ipsilateral
Oophoropexy to potentially prevent further torsion. Detorsion of the adnexum was achieved
laparoscopically and the right ovarian ligament was plicated to the right uterosacral ligament using
PDS suture material. Ovarian torsion presents an acute gynaecological emergency with the
potentially devastating consequence of loss of the affected ovary and so prompt diagnosis and
management is essential. Recommended surgical methods to prevent recurrent torsion include
suturing the ovary/pedicle to the pelvic sidewall or to the round ligament or plication of the utero-
ovarian ligaments. These have however been reported to increase risks of pelvic pain and adhesions
and their effectiveness in reducing recurrent torsion after one episode of torsion remains uncertain.
There is evidence to support performance of Oophoropexy after two or more episodes of torsion
both from published literature and as a good practice principle. Conclusions Oophoropexy is an
effective surgical method to prevent recurrence after two or more episodes of ovarian torsion.
Plication of utero-ovarian ligaments remains the most anatomically feasible method.
Database: EMBASE

22. Management of Isolated Tubal Torsion in a Premenarchal Adolescent Female with Prior
Oophoropexy: A Case Report and Review of the Literature
Author(s): Blitz M.J.; Appelbaum H.
Source: Journal of Pediatric and Adolescent Gynecology; Aug 2013; vol. 26 (no. 4); p. 95-97
Publication Date: Aug 2013
Publication Type(s): Article
PubMedID: 23602040
Abstract:Background: Isolated tubal torsion in a premenarchal adolescent girl is a rare phenomenon.
Preoperative diagnosis remains a challenge. Case: A 14-year-old premenarchal girl, with a history of
bilateral ovarian torsion treated by laparoscopic detorsion and oophoropexy two years prior,
presented to the emergency room with lower abdominal pain accompanied by nausea and vomiting.
Pelvic ultrasound demonstrated an enlarged left adnexa. Diagnostic laparoscopy revealed an
isolated left tubal torsion. Surgical evidence of previous bilateral plication of the utero-ovarian
ligaments was confirmed. Untwisting of the left fallopian tube immediately restored the vascular
supply. Subsequently, her symptoms resolved. Summary and Conclusion: Clinicians should consider
torsion of the fallopian tube in the differential diagnosis of lower abdominal pain in all female
patients. Prompt laparoscopic intervention is essential. Oophoropexy, while usually efficacious, may
not prevent recurrence. © 2013.
Database: EMBASE

23. "Habitual Adnexal Torsions" -Recurrence after Two Oophoropexies in a Prepubertal Girl: A
Case Report and Review of the Literature
Author(s): Sheizaf B.; Ohana E.; Weintraub A.Y.
Source: Journal of Pediatric and Adolescent Gynecology; Jun 2013; vol. 26 (no. 3)
Publication Date: Jun 2013
Publication Type(s): Article
PubMedID: 23518360
Abstract:Background: Recurrent adnexal torsion rarely affects girls. Various surgical techniques for
its prevention are available. We describe a case of recurrent asynchronous bilateral torsions in a
prepubertal patient. Case: An 8-year-old girl first presented with a right adnexal torsion and
underwent a laparoscopic untwisting. During the following 3 years, 4 additional laparoscopies were
required for treatment of left adnexal torsions. Although undergoing bilateral utero-ovarian
ligament plication twice, torsion recurred. After examining the various options, we fixated the left
ovary to the sidewall just below the pelvic brim. Summary and Conclusion: In the absence of clear
evidence, treatment should be flexible and dependent on the individual case. Thorough patient
education is imperative in order to prevent a delay in diagnosis and treatment of recurrent adnexal
torsion. © 2013 North American Society for Pediatric and Adolescent Gynecology.
Database: EMBASE

24. Torsion of the ovary in an incarcerated inguinal hernia

Author(s): Pampal A.; Atac G.K.
Source: Pediatric Emergency Care; Jan 2013; vol. 29 (no. 1); p. 74-75
Publication Date: Jan 2013
Publication Type(s): Article
PubMedID: 23283269
Available at Pediatric Emergency Care - from Ovid (LWW Total Access Collection 2015 - Q1 with
Neurology)
Abstract:A 2.5-month-old girl with a left-sided, painful inguinal swelling for the last 2 days was
brought to the emergency department. After physical examination and radiological evaluation, the
diagnosis of incarcerated inguinal hernia of the ovary was made. Because of the long-standing
history, she was taken to the operation room without an attempt for manual reduction.
Perioperatively, the torsion of the ovary with distal fallopian tube within the indirect hernia sac was
seen. As untwisting of the ovary has resulted in no change in the color, oophorectomy before hernia
repair was performed.The majority of the painful inguinal swellings in the infancy are related to
incarcerated hernia. The treatment option varies from manual reduction to surgical intervention,
depending on the duration from beginning of swelling to the time the exact diagnosis was made.
Even though the presence of short-term history and the lack of peritoneal irritation findings are
indications for a manual reduction, the suspicion of an ovarian torsion should be raised for ovaries
within the incarcerated inguinal hernia, and ovarian viability should be considered before an attempt
of manual reduction. Copyright © 2013 by Lippincott Williams & Wilkins.
Database: EMBASE

25. Laparoscopic management of a torted hyper stimulated ovary

Author(s): Shakir F.; Shakir T.
Source: BJOG: An International Journal of Obstetrics and Gynaecology; Jun 2012; vol. 119 ; p. 156
Publication Date: Jun 2012
Publication Type(s): Conference Abstract
Available at BJOG: An International Journal of Obstetrics and Gynaecology - from Wiley Online
Library Science , Technology and Medicine Collection 2017
Available at BJOG: An International Journal of Obstetrics and Gynaecology - from Unpaywall
Abstract:Objective: Torsion of a hyperstimulated ovary occurring after in vitro fertilisation (IVF) is
rare. We present a case where the management of a patient with a torted hyper stimulated ovary
was dealt with laparoscopically. Methods: A 37 year old patient who was 8 weeks pregnant
presented acutely to the emergency department with acute onset right iliac fossa pain. This was an
IVF pregnancy and she had no complications prior to this episode. At presentation she had an acute
abdomen and was tachycardic. A pelvic ultrasound scan was performed promptly and demonstrated
a normal ongoing intrauterine pregnancy together with a cystic area around the right ovary, with
minimal intra-peritoneal free fluid. The ultrasound diagnosis was a heterotopic pregnancy and the
patient was placed on the emergency operating theatre list for a laparoscopy. Results: At
laparoscopy no instrumentation of the uterus was made and bilateral enlarged hyperstimulated
ovaries were noted. The right ovary appeared grossly enlarged with a dusky colour and areas of
haemorrhage. Further exploration demonstrated that the ovary was torted at its pedicle. Untwisting
of the ovary restored its normal anatomy. The patient made a prompt recovery. The rest of her
pregnancy was uneventful and she had a normal successful vaginal delivery. Conclusion: Ovarian
torsion is a rare but recognised complication that can occur in pregnant patients with
hyperstimulated ovaries following IVF. Assisted fertility is increasing and obstetricians and
gynaecologists together with emergency department doctors need to be aware of this possible
diagnosis. Prompt diagnosis and management can lead to preservation of the ovary and no
deterioration clinically. Laparoscopy together with untwisting the ovary is a simple and effective
technique that should be used if appropriate.
Database: EMBASE

26. Recurrence of ovarian torsion after bilateral synchronous torsion and oophoropexy: A case
report and review of the literature
Author(s): Yates M.; Brecht-Doscher A.
Source: Journal of Pediatric and Adolescent Gynecology; Apr 2012; vol. 25 (no. 2)
Publication Date: Apr 2012
Publication Type(s): Conference Abstract
Abstract:Background: In children and adolescents, ovarian torsion occurs 27.5% of the time in
otherwise normal ovaries. Bilateral asynchronous torsion is reported in 11% of torsions with normal
ovaries. Ovarian conservation and prophylactic oophoropexyare proposed to decrease the risk of
ovarian failure. However, theoptimal timingandtechnique foroophoropexyremainsunclear. Case: We
report a case of a 13 year old who presented with bilateral synchronous torsion. She underwent
unilateral oophorectomy and oophoropexy of the contralateral ovary by plication of the utero-
ovarian ligament. 9 months later she had recurrence of abdominal pain. After a delay of diagnosis
for 5 days, she was diagnosed with recurrent ovarian torsion. She was treated laparoscopically with
an untwisting of the ovary and ovarian conservation. The prior oophoropexy was clearly visible.
However, the patient had no return of ovarian function. Comments: This case is remarkable for the
presentation of synchronous torsion in normal ovaries and subsequent recurrent torsion after
oophoropexy. This is one of few case reports of torsion after oophoropexy. This case reinforces the
importance of continued education of primary providers on the signs, symptoms and ultrasound
findings of ovarian torsion, and the importance of increased suspicion in patients with a prior torsion
even after oophoropexy. It also demonstrates the importance of continued education of
gynecologists and surgeons on the consideration for ovarian conservation in cases of torsion and the
need for further research in effective methods and timing for oophoropexy.
Database: EMBASE

27. Management of ovarian torsion in in vitro fertilization pregnancy

Author(s): Chin H.; Hendricks M.
Source: Journal fur Reproduktionsmedizin und Endokrinologie; 2010; vol. 7 (no. 4); p. 306
Publication Date: 2010
Publication Type(s): Conference Abstract
Abstract:Ovarian torsion is an uncommon cause of surgical emergency in pregnancy with an
occurrence of 1 in 5000 pregnancies. The incidence of ovarian torsion in in vitro fertilization (IVF)
pregnancies ranges from 0.08% to 0.13%. The occurrence of ovarian torsion in ovarian cysts in
pregnancy ranges from 1% to 15%. The risk of ovarian torsion associated with OHSS increases if
patients become pregnant subsequently. Adnexal masses with sizes between 6 and 8 cm have a
higher risk of torsion, at an odds ratio of 2.8, especially between 10th and 17th week of gestation.
We report a series of 4 cases of ovarian torsion in IVF pregnancies, ranging from 6th to 13th week of
gestation. All presented with iliac fossa pain of the affected side. Ovarian size ranges from 7.5 to
11.3 cm on ultrasound. Color Doppler is helpful in these cases by demonstrating lack of vascularity in
the affected ovary. 2 patients experienced moderated OHSS before the index event. 1 patient
underwent diagnostic laparoscopy with the affected ovary appearing necrotic after untwisting.
Decision was made for open salpingo-oophorectomy. 3 other patients underwent laparoscopic
untwisting +/- cystectomy with successful conservation of the ovaries. Early recognition and prompt
intervention are essential for salvage of the affected ovary. Laparoscopic technique is an effective
modality of treatment with lesser morbidities to the patient.
Database: EMBASE

28. Laparoscopic management of twelve consecutive cases of ovarian torsion: Four years
experience
Author(s): Olowu O.; Odejinmi F.; Hapeshi D.
Source: International Journal of Gynecology and Obstetrics; Oct 2009; vol. 107
Publication Date: Oct 2009
Publication Type(s): Conference Abstract
Available at International Journal of Gynecology and Obstetrics - from Wiley Online Library Science ,
Technology and Medicine Collection 2017
Abstract:Objective: To determine the outcome of laparoscopic surgery, complications and
histological types in women undergoing surgery for ovarian torsion. Methods: We conducted a
prospective data base cohort study of 12 consecutive emergency laparoscopic surgically proven
ovarian torsion in women with radiologic and laboratory features suggestive of benign disease, from
2005 to 2008. Patients' information including demographic, clinical and ultrasound features, CA- 125
values, surgical procedures, operative and post-operative complications, estimated amount of blood
loss (EBL), and the pathologic findings were recorded. Results: Twelve consecutive patients
underwent emergency laparoscopic surgery for ovarian torsion. The mean (range) age was 28 (18-45
years). All cases had ultrasound features of benign ovarian cyst (measured 8-20 cm). The main
clinical features included: sudden pain (100%), nausea/vomiting (7/12, 58%) and palpable abdominal
mass (9/12, 75%). There is one case of 14 weeks pregnant. Median symptom duration was 3 days.
Median time to diagnosis was 24 h. The diagnosis was made at surgery (100%) with clinically
suspicion in 5 (42%) and sonographic suspicion/confirmation in 2 (17%) cases. Ca-125 level was
normal in 83% and 17% (2) was above 35 mg/mL. Laparoscopic surgery was successful in 100% of
patients. The surgical procedures performed were: untwist and ovarian cystectomy (OC) (n = 3),
salpingo-oophorectomy (SO) (n = 9). The cysts were extracted using endo-bag through the lower
suprapubic incision (n = 7) or the umbilical incision (n = 5). There were no operative or post-
operative complications. The mean (range) operative time of 48 (35-60 min), EBL 75 (50-160 mls)
and hospital stay of 24 (0-48 hours). Pathologic findings were: functional benign cysts (n = 5),
dermoid (n = 5), fibroma (n = 1), Serous borderline ovarian tumor (n = 1). All nine salpingo-
oophorectomies specimen are reported as haemorrhagic ischaemic necrosis. One of the three
cystectomy specimen was serous borderline tumor in a woman with unusual bilateral torsion of
large ovarian cysts (right SO and left untwist and OC). Conclusion: Clinical picture of ovarian torsion
lack sensitivity and specificity and ultrasound diagnosis is not definitive. Laparoscopy surgery is
feasible and safe for women even with large ovarian cysts torsion with benign features and results in
a short hospital stay. Ovarian preservation occurred in 3 (25%) cases with demonstrable association
to patient age, time to diagnosis and fertility consideration in our study.
Database: EMBASE

29. Detorsion and conservative therapy for twisted adnexa: our experience.
Author(s): Tandulwadkar, Sunita; Shah, Amit; Agarwal, Bhavana
Source: Journal of gynecological endoscopy and surgery; Jan 2009; vol. 1 (no. 1); p. 21-26
Publication Date: Jan 2009
Publication Type(s): Journal Article
PubMedID: 22442506
Available at Journal of gynecological endoscopy and surgery - from Europe PubMed Central - Open
Access
Available at Journal of gynecological endoscopy and surgery - from Free Medical Journals . com
Available at Journal of gynecological endoscopy and surgery - from ProQuest (Health Research
Premium) - NHS Version
Available at Journal of gynecological endoscopy and surgery - from Unpaywall
Abstract:OBJECTIVE1) To determine if detorsion of the twisted adnexa is better than traditional
adnexectomy to conserve the adnexa and preserve its function. 2) To determine the feasibility of
detorsion in conservation of adnexa.DESIGNProspective Study from September 2004 to September
2008.SETTINGPrivate IVF and Endoscopy Centre.PATIENTS22 patients with twisted adnexa (15 non-
pregnant and 7 pregnant).INTERVENTIONSurgical intervention and either detorsion of adnexa or
adnexectomy.MAIN OUTCOME MEASURESOvarian preservation and conservation of ovarian
function in 77.2% cases determined by: a) Follicular development on sonography (performed for one
year after adnexectomy). b) Subsequent surgery for unrelated cause showing healthy ovaries. c)
controlled ovarian hyperstimulation and successful oocyte retrieval subsequently.RESULTSWe could
conserve the adenexa in 77.2% cases. Laparoscopic detorsion was performed in 11/15(73.33 %) of
non-pregnant women and adnexectomy done in four women 26.66%. Among the seven pregnant
women, adnexa could be preserved in 6/7(85.7%) and only one woman required adnexectomy.
Laparotomy was required in 2/22(9%) women both of which were in late second trimester of
pregnancy. In one case (4.54%) we had recurrence of torsion. 88.23% of the women with conserved
adnexa showed preservation of ovarian function.CONCLUSIONOur study showed that timely
diagnosis and intervention could make the difference between ovarian loss and salvage- an outcome
of great importance in population of reproductive age females. Laparoscopy with its many benefits
proves to be superior to laparotomy.
Database: Medline

30. Long-term results of conservative management of adnexal torsion in children.

Author(s): Celik, Ahmet; Ergün, Orkan; Aldemir, Hakan; Ozcan, Coşkun; Ozok, Geylani; Erdener, Ata;
Balýk, Erol
Source: Journal of pediatric surgery; Apr 2005; vol. 40 (no. 4); p. 704-708
Publication Date: Apr 2005
Publication Type(s): Journal Article
PubMedID: 15852284
Abstract:BACKGROUND/PURPOSEAdnexal torsion is a condition that may result in serious morbidity
including adnexal removal. However, conservative management with preserving the torsed adnexa
is not justified, and long-term outcomes remain unclear.METHODSThe records of 14 girls with
ovarian torsion whose adnexal structures were preserved after detorsion were reviewed to evaluate
the long-term results of conservative management. Data including age, previous history, duration of
complaints, surgical findings and type of intervention, color Doppler ultrasound findings performed
in the early and late postoperative periods, and final outcomes were collected.RESULTSMean age of
patients was 11.5 +/- 2.8 (range 6 to 15) years. Time interval between the onset of pain to surgery
was 46.78 +/- 35.5 (range 12 to 126) hours. Seven patients had a benign solitary cyst as an
underlying cause for adnexal torsion. The intervention performed by open surgery in 9 and by
laparoscopy in 5 patients included detorsion, simple cyst aspiration, unroofing and/or cystectomy in
7 patients with ovarian cysts, and oophoropexy in 9 of 14 patients. Follow-up ranged from 3 to 66
(mean 21.9 +/- 20.1) months. Thirteen patients resumed normal size and folliculogenesis, whereas in
1 patient, the involved ovary atrophied. No recurrence or contralateral adnexal torsion was
observed on follow-up.CONCLUSIONSConservative management with untwisting the ovary and
pexing both retained detorsed and contralateral ovaries especially in idiopathic torsions should be
considered in cases of ovarian torsion in children.
Database: Medline

31. Adnexal torsion in children may have a catastrophic sequel: asynchronous bilateral torsion.
Author(s): Ozcan, Coşkun; Celik, Ahmet; Ozok, Geylani; Erdener, Ata; Balik, Erol
Source: Journal of pediatric surgery; Nov 2002; vol. 37 (no. 11); p. 1617-1620
Publication Date: Nov 2002
Publication Type(s): Case Reports Journal Article Review
PubMedID: 12407550
Abstract:BACKGROUND/PURPOSEAdnexal torsion is a serious condition that frequently may result in
ovarian removal, and there always is a risk of castration if the contralateral ovary undergo torsion as
well. In this study, the authors present their experience with adnexal torsion in 15 children and
describe a catastrophic event, asynchronous bilateral adnexal torsion, with review of the
literature.METHODSBetween November 1993 and November 2000, 15 children under 15 years of
age who had undergone operation because of torsion of uterine adnexal structures were evaluated.
Two illustrative cases with asynchronous bilateral adnexal torsion are presented.RESULTSFourteen
cases were associated with additional adnexal pathology, whereas in 1 case the torsion was of
normal uterine adnexa. Sonographic studies improved the preoperative diagnosis. Hemorrhagic
necrosis of the adnexa secondary to the torsion was found in all cases except 3 and necessitated
adnexal resection. In only 3 cases preservation of the adnexa was possible. Asynchronous adnexal
torsion occurred in 2 patients in the time course. Both were treated by laparotomy and adnexal
untwisting and fixation by permanent multiple interrupted sutures. In their final evaluation at 40 and
8 months after the operation, they were found to have good ovarian
function.CONCLUSIONConsidering the risk of subsequent contralateral torsion and its impact on
future fertility, the authors believe that conservative management (untwisting the ovary and pexing,
both retained detorsed and contralateral, ovaries) should be considered in cases of ovarian torsion
in children.
Database: Medline

32. Laparoscopic detorsion allows sparing of the twisted ischemic adnexa.

Author(s): Cohen, S B; Oelsner, G; Seidman, D S; Admon, D; Mashiach, S; Goldenberg, M
Source: The Journal of the American Association of Gynecologic Laparoscopists; May 1999; vol. 6
(no. 2); p. 139-143
Publication Date: May 1999
Publication Type(s): Journal Article
PubMedID: 10226121
Abstract:STUDY OBJECTIVETo determine the safety and outcome of laparoscopic detorsion in the
management of the twisted ischemic, hemorrhagic adnexa.DESIGNRetrospective chart review and
prospective follow-up (Canadian Task Force classification II-2).SETTINGUniversity-affiliated
hospital.PATIENTSFifty-eight women with twisted black-bluish ischemic adnexa encountered at
laparoscopy.INTERVENTIONLaparoscopic detorsion with adnexal sparing.MEASUREMENTS AND
MAIN RESULTSAll patients had a benign immediate postoperative course. Transient temperature
elevation occurred in seven women (12.1%). No signs of pelvic or systemic thromboembolism were
detected in any patient. Long-term follow-up included transvaginal ultrasound, which revealed
follicular development in the previously twisted adnexa in 54 women; normal macroscopic
appearance at incidental subsequent surgery in 9; and in vitro fertilization with retrieval of oocytes
from the previously twisted side in 4.CONCLUSIONLaparoscopic detorsion of the twisted ischemic,
hemorrhagic adnexa is a safe procedure with minimal postoperative morbidity and a potential for
the ovary to recuperate fully with preservation of normal function. Laparoscopic adnexa-sparing
procedures should be performed in place of traditional salpingo-oophorectomy in women with this
disorder who desire future fertility. (J Am Assoc Gynecol Laparosc 6(2):139-143, 1999)
Database: Medline

33. Long-term follow-up of the twisted ischemic adnexa managed by detorsion.

Author(s): Oelsner, G; Bider, D; Goldenberg, M; Admon, D; Mashiach, S
Source: Fertility and sterility; Dec 1993; vol. 60 (no. 6); p. 976-979
Publication Date: Dec 1993
Publication Type(s): Journal Article
PubMedID: 8243702
Abstract:OBJECTIVETo examine our assumption that although the twisted adnexa appears ischemic-
hemorrhagic, it can safely be revived by detorsion with preservation of ovarian
function.DESIGNPatients' records were obtained from a computerized database and reviewed. The
preoperative diagnosis of adnexal torsion was based upon patients' symptoms, clinical examination,
laboratory investigations, and ultrasound scanning.SETTINGGynecology department at a large
teaching hospital receiving primary referrals of public sector patients.PATIENTSIn 40 patients who
presented with signs and symptoms suggestive of ovarian torsion, "black-bluish" ischemic adnexa
were encountered at surgery.INTERVENTIONSAll patients were managed by unwinding of the
adnexa: laparotomy in 26 cases and operative laparoscopy in 14. In 13 patients detorsion only was
performed, in 15 detorsion and cystectomy were carried out, and in 12 patients detorsion was done
and ovarian cysts aspirated.MAIN OUTCOME MEASURESPostoperative course, mean hospitalization
period, follow-up pelvic examination, ovarian folliculogenesis on ultrasound examination, and
oocyte retrieval and fertilization.RESULTSThe size of the twisted ovary ranged from 4 to 20 cm
(mean, 9.5 cm). The postoperative course was uneventful, except for transient temperature
elevation in five patients. The mean hospitalization period was 6.5 days (range 5 to 10 days) after
laparotomy and 1.8 days (range 1 to 3 days) after laparoscopy. Three patients were lost to follow-up.
In 37 patients, pelvic examination was normal. A normal sized ovary, with follicular development,
was demonstrated sonographically in 35 of 37 patients. In 6 of 7 patients, macroscopically normal
adnexa were visualized at subsequent laparotomy or laparoscopy. In two patients undergoing IVF,
oocytes were retrieved and fertilized from the detorted ovary. The patency of the fallopian tube was
demonstrated in four cases.CONCLUSIONSThis new "adnexal-sparing" approach should be applied
instead of the traditional salpingo-oophorectomy in young women with twisted ischemic adnexa.
Database: Medline
Strategy 642314

# Database Search term Results

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3 EMBASE ("ovarian torsion").ti,ab 1058

4 EMBASE ("ovar*twist" OR "ovar* 1079

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5 EMBASE (1 OR 2 OR 3 OR 4) 1346

6 EMBASE (untwist*).ti,ab 1215

7 EMBASE (5 AND 6) 53

8 EMBASE (torsion ADJ 2 remov*).ti,ab 0

9 EMBASE (torsion ADJ 2 unwind*).ti,ab 0

10 EMBASE (detorsion).ti,ab 1276

11 EMBASE (remov* OR unwind* OR 1429435

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12 EMBASE (6 OR 10 OR 11) 1431543

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