From
Grand Rounds
GYN #3 Management of an Adnexal Torsion with a Healthy Appearing Ovary with Dr. Lesley Breech
With Dr. Lesley Breech · hosted by Dr. M. Goti
Part of
Adnexal Torsion 3 items
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What the experts said
When managing ovarian torsion, the goal is to never take an ovary out
A severely damaged fallopian tube can develop into a hydrosalpinx, which negatively impacts IVF success and leads to ectopic pregnancies
After detorsion, if a fallopian tube looks severely damaged, it should be photographed and documented to inform long-term care providers about its condition
When a fallopian tube has had significant trauma without improvement in health, removal of the tube should be considered to decrease further reproductive risk associated with a poorly functional tube
In gynecology, recurrent torsion is defined as occurring more than once
Elevated CA-125 in torsion is due to the inflammation process, not tumor presence
For suspected torsion, the patient should be taken to the OR, the structure detorsed, and management decisions made based on intraoperative findings, with follow-up later
Dr. Breech's goal is to retain reproductive structures, but fallopian tubes are not as durable, strong, or resilient as ovaries
When resecting structures, complete resection is important because Wolffian duct remnants will recur if not fully removed
Oophoropexy should not be performed at the time of detorsion but should be considered as an interval procedure
After puberty, birth control pills can be prescribed to suppress the ovary, keep ovaries small, minimize cysts, and decrease the risk of recurrent torsion
Before puberty (in 8-10 year olds), hormonal suppression is not an option and oophoropexy is the only intervention for recurrent torsion
There are no specific blood tests that should be sent prior to surgery for suspected torsion
Tumor markers like CA-125 are non-specific and will likely be elevated in torsion cases, causing confusion about management strategies
From a gynecologic standpoint, the approach should be to wait, reassess, and perform an interval ovarian cystectomy if needed to preserve fertility