Ovarian Torsion · Preserve vs Remove

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] Emergency exploration → post-detorsion viability/menopause/suspected malignancy
   Post-detorsion ovarian viability? Menopausal status? Suspected malignancy? (Surgical emergency: sudden pelvic pain + adnexal mass should raise high suspicion; preserved Doppler flow does not exclude torsion (intermittent/venous involvement first), high clinical suspicion warrants emergency laparoscopic exploration without delay.)
   • Ovary viable after detorsion (even with transient dusky/ischemic appearance), premenopausal → Detorsion + preserve ovary
   • Clear irreversible necrosis/severe friability or postmenopausal/suspected malignancy → Adnexectomy
2. [End] Detorsion + preserve ovary
   Detorsion + ovarian preservation (even if dusky/ischemic-appearing, function usually recovers, the necrotic appearance is unreliable); cystectomy if there is a cyst; consider oophoropexy for recurrence or a solitary ovary; avoid easy removal.
3. [End] Adnexectomy
   Clear irreversible necrosis/severe friability or postmenopausal/suspected malignancy → adnexectomy (ovary ± tube); for suspected malignancy follow oncologic principles, avoid cyst rupture and spillage, and perform staging assessment.

Source guidelines & references

• Ovarian torsion management (ACOG; emphasis on detorsion and ovarian preservation)

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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