Adnexal Torsion in Premenopausal Patients When Detorsion Has Not Restored Ovarian Function

Clinical scenario

A premenopausal patient with adnexal torsion in whom initial surgical management has been attempted but has not achieved revascularisation or return of ovarian function, leaving the affected ovary non-viable.

Prior treatment and why escalation is needed

The first-line approach — laparoscopic detorsion of the adnexa, with or without ovarian cystectomy, oophoropexy, or aspiration of a cyst — aims to untwist the affected ovary and restore blood flow. This protocol applies when those goals were not achieved: the ovary failed to revascularise and ovarian function was not preserved, confirming adnexal necrosis.

Next clinical step

When the affected ovary is confirmed necrotic and non-viable in a premenopausal patient, the structured regimen for this situation involves a surgical intervention targeting the non-viable adnexal tissue. The full operative protocol with stepwise decision criteria is available below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/tog.12985

Current consensus is that laparoscopic detorsion in pre-menopausal cases preserves ovarian function to support future pregnancy.
The management of OT differs significantly in postmenopausal patients compared to premenopausal; there is no prioritisation of hormonal or fertility preservation driving the need for conservative measures.
As previously discussed, oophorectomy should no longer be performed unless there is necrosis and ovarian degradation as ovarian function has been shown to be preserved.

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