title: Re-torsion of the ovaries.
abstract: 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 pre-menarcheal girls, and fertile and pregnant women. We clinically reviewed PubMed, Embase, Trip and Cochrane databases. The main outcome measures were re-torsion and viability of ovary with fixation measures. 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 may prevent re-torsion. In one case a girl experienced re-torsion after ovariopexy. 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.
authors.affiliation: Department of Anesthesiology, Vendsyssel Hospital, Hjørring, Denmark.
authors.forename: Trine E W
authors.initials: TE
authors.lastname: Hyttel
authors.forename: Geske S
authors.initials: GS
authors.lastname: Bak
authors.forename: Solveig B
authors.initials: SB
authors.lastname: Larsen
authors.forename: Ellen C L
authors.initials: EC
authors.lastname: Løkkegaard
mesh_terms: D000291:Adnexal Diseases / Q000453:epidemiology* / Q000601:surgery; D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D010048:Ovarian Cysts / Q000453:epidemiology; D010053:Ovary / Q000601:surgery; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000601:surgery; D012307:Risk Factors; D014102:Torsion Abnormality / Q000453:epidemiology* / Q000601:surgery; D055815:Young Adult
keywords: Torsion; ovary; pregnancy; recurrence; surgery; uterine adnexa