Re-torsion of the ovaries

• T.E.W. Hyttel
• G.S. Bak
• S.B. Larsen
• Løkkegaard Ellen C.L.

Abstract

Objective. The increasing use of de-torsion of the ovaries may result in re-torsion. This review addresses risk of re-torsion and describes preventive strategies to avoid re-torsion in premenarcheal girls, and fertile and pregnant women.

Method. Clinical review using the PubMed, Embase, Trip and Cochrane databases.

Main outcome measures. Re-torsion, viability of ovary with fixation measures.

Results. A total of 38 publications including 71 girls, 363 fertile women, and 69 pregnant women were found to be relevant. All studies were case-reports or case series, sometimes with non-randomized controls. The studies show considerable heterogeneity in design, population, management and outcome. Only four studies included more than 50 cases. In pregnancy the risk of re-torsion was as high as 19.5–37.5%, among fertile women it was 28.6%. Most articles concluded that fixation of the ovaries to the pelvic sidewall or plication of the ovarian ligament after torsion could be considered to prevent re-torsion. In one case a girl experienced re-torsion after ovarypexy.

Conclusion. Based on observational studies it seems that de-torsion and fixation of the ovary is a safe procedure that usually ensures maintenance of ovarian function and reduces the risk of recurrence, especially when there are no ovarian cysts or adnexal masses.

Keywords:torsion, ovary, uterine adnexa, surgery, recurrence, pregnancy