Management and Treatment of Ovarian Torsion

Clinical Presentation and Diagnosis

Ovarian torsion typically presents as severe, constant pain that may fluctuate in intensity but rarely completely resolves without intervention 1
Ultrasound is the first-line imaging modality with key findings including unilaterally enlarged ovary (>4 cm or volume >20 cm³) 1
Ultrasound findings also include peripheral follicles (found in up to 74% of cases) and abnormal or absent venous flow (100% sensitivity, 97% specificity) 1
The whirlpool sign has a 90% sensitivity in confirmed cases of ovarian torsion 1
Normal arterial blood flow does not rule out ovarian torsion, as torsion can be intermittent or partial 1
When ultrasound findings are inconclusive but clinical suspicion remains high, MRI (80-85% sensitivity) or CT may be utilized 1

The standard approach for managing ovarian torsion includes immediate surgical intervention with laparoscopic detorsion to preserve ovarian function, regardless of the macroscopic appearance of the ovary 1
Oophorectomy should be considered only in cases of definitive necrosis with no signs of recovery after detorsion, large malignant masses, or in postmenopausal women 2

Ovarian torsion can mimic other conditions such as appendicitis, renal colic, or urinary tract infection, leading to diagnostic delays 1