Adnexal torsion in adolescents is a complex clinical problem given the need for ovarian preservation in this age group. It is a surgical diagnosis and while imaging modalities may be helpful in the diagnosis, clinical judgement is paramount. ACOG (2019) released a committee opinion regarding torsion in this population, to aid in diagnosis and management.
Note: If CT or MRI are done first and are suspicious for torsion, do not delay surgery while waiting for ultrasound
Adnexal torsion, especially in this age group, is a surgical diagnosis and the clinical signs may be non-specific. Ultrasound is the imaging modality of choice which should show an enlarged ovary. Oophorectomy should be reserved for ovaries that are necrotic and falling apart. Otherwise untwist the ovary and monitor. Because recurrence is unlikely and data is limited, oophoropexy to prevent recurrence is not recommended.
Note: Only a necrotic ovary that falls apart intraoperatively should be removed
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