Clinical Scenario

This protocol applies to postmenopausal patients presenting with adnexal torsion where clinical assessment raises a high index of suspicion for underlying ovarian malignancy. In this population, reported malignancy rates based on frozen section histology range between 9% and 22%, making careful pre- and intra-operative evaluation essential.

Key Consideration

Postmenopausal Status

Postmenopausal patients presenting with ovarian torsion warrant heightened vigilance for malignancy. This significantly shapes the surgical strategy — both the extent of resection and the operative approach must account for the risk of disseminating malignant disease.

Approach — Partial Overview

Surgical management is indicated, involving resection of the affected adnexa. The operative approach — whether minimally invasive or open — is guided by the need to minimise the risk of cyst rupture and spillage of contents. Pain management is addressed to facilitate complete pre-operative assessment.

The full protocol specifies the complete surgical decision pathway, including criteria for escalation beyond the minimum procedure — access it via the link below.

References

DOI: 10.1111/tog.12985

OT in postmenopausal patients should be accompanied by a high index of suspicion for malignancy, the rate of which is reported between 9% and 22%, based on frozen section histology.
At a minimum, salpingo-oophorectomy is the appropriate surgical management, however, more substantial staging surgery or hysterectomy may be advised.
The risk of rupture and spill of any cyst contents leading to potential seeding of malignancy should also be considered, and open surgery performed if deemed to reduce this risk.
If the patient is experiencing pain, this can be addressed with analgesia to allow full investigations.

View source ↗

Treatment of Adnexal Torsion in Postmenopausal Women with High Suspicion of Ovarian Malignancy

References