Time's a tickin': When should surgical intervention occur in ovarian torsion?

The standard of care for adnexal torsion in children is surgical detorsion and ovarian preservation. However, the duration of symptoms beyond which irreversible tissue damage occurs is unknown. Our objective was to define an upper limit for the window of viability when performing surgical intervention in pediatric patients with ovarian torsion.

We conducted a single institution retrospective case series of pediatric and adolescent patients (age 1-17 years) diagnosed with adnexal torsion from April 2015 to June 2024 to investigate the association of symptom duration and long-term adnexal viability. Patients with long term adnexal preservation vs. loss were compared using bivariate and logistic analyses.

There were 95 cases with suspected ovarian torsion who underwent operative intervention from April 2015 to July 2024. Of 34 patients meeting inclusion criteria, ovarian detorsion was performed in 22 patients and 12 patients were treated with oophorectomy and/or salpingectomy. Three patients (14 %) initially treated with ovarian detorsion required a second operation for detorsion within 12 months. One patient (8.7 %) was found to have no visible ovary on postoperative ultrasound 32 days after detorsion. Receiver operating characteristic curve analysis identified optimal cutoff time from symptom onset to operating room of 34.7 h (area under the curve: 0.73). Upon logistic regression, patients with duration from symptom onset to operating room of ≥34 h had 6.67-fold higher odds of adnexal organ loss compared to those with symptom duration <34 h (95 % CI 1.38-32.28; p = 0.02).

Our institutional series identified a possible upper limit of 34 h from symptom onset to detorsion to be associated with ovarian viability as documented on postoperative ultrasonography. We believe that all children and adolescents should be treated with urgent ovarian conservation that should occur well within 34 h of symptom onset.

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