Ovarian torsion: can we save the ovary?

Abstract

The purpose of this study is to evaluate the correlation between visually appearing ovarian necrosis and necrosis in histopathology in patients with ovarian torsion; and to identify predictive factors of ovarian necrosis. This is a retrospective study. All women admitted to the hospital with a diagnosis of suspected ovarian torsion from January 2014 to December 2018 were recruited. Forty-two patients with a confirmed diagnosis of ovarian torsion were finally included. Correlation analysis was done between visual judgement of ovarian necrosis and necrosis in histopathology. Chi-square was performed to analyze dependence between time frompainonset tosurgery, ovarian size in ultrasound, Doppler flow, and histopathologicalanalysis. Thirty-one ovaries were visually judged as necrotic. Only five of them (16%) had histopathologically confirmed necrosis, 20 (64.5%) had hemorrhage or congestion, and 6 (19%) had normal ovarian tissue, p = 0.349. Development of ovarian necrosis showed to be dependent on time from onset of pain to surgery. All patients with necrotic ovaries in histopathology underwent surgery after 24h of pain onset, while there was no necrosis in those who had surgery before 24h. (p = < 0.05). There was no relationship between ovarian size measured by ultrasound and necrosis (p = 0.265), as well as color flow in ultrasound and necrosis (p = 0.388). Visual assessment of ovarian necrosis intraoperatively is not a good predictor of real necrosis in histopathology. To preserve the ovary, surgical management should not be delayed.