Ovarian / Adnexal Torsion — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Clinically suspected torsion?
   Sudden unilateral pelvic pain + nausea — is torsion clinically suspected? (Gynecological emergency. Sudden severe unilateral lower abdominal/pelvic pain (often sharp, may radiate to the groin) + nausea/vomiting; risk factors = enlarged ovary/mass (>5 cm), pregnancy, reproductive age. First-line transvaginal/pelvic Doppler ultrasound ('whirlpool sign', enlarged ovary); normal Doppler flow does not exclude torsion (do not decide on Doppler alone). Labs are usually normal.)
   • Torsion clinically suspected → Suspected torsion → laparoscopic detorsion, preserve ovary
   • Not supportive, consider other causes → Not supportive
2. [End] Not supportive
   Differentiate other causes of acute pelvic pain — ruptured hemorrhagic ovarian cyst, appendicitis, ectopic pregnancy, renal colic, PID — and manage along the appropriate pathway; high suspicion with atypical imaging still warrants surgical exploration.
3. [End] Suspected torsion → laparoscopic detorsion, preserve ovary
   Surgical emergency, laparoscopy as soon as possible: detorsion (untwist) + ovary preservation (untwist even if dusky/edematous; >90% recover function; blue-black ≠ necrosis); perform adnexectomy only for clear necrosis, suspected malignancy or postmenopausal status. Time-sensitive (prolonged ischemia causes loss of function), early gynecology consult; a negative laparoscopy is acceptable.

Source guidelines & references

• ACOG adnexal torsion; UpToDate ovarian/tubal torsion

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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