Ovarian torsion can cause severe pain and other symptoms because the ovary is not receiving enough blood due to twisting of its blood supply. It can occur at any age and is responsible for nearly three percent of all gynecologic emergencies. An oophorectomy is performed when there is concern that the torsed ovary is nonviable (necrosis) based on its dusky color. However, numerous studies have shown that a surgeon's ability to determine necrosis based on physical appearance is inaccurate.
To determine the factors associated with an increased likelihood for ovary removal during the time of surgery for ovarian torsion, researchers from Boston University School of Medicine (BUSM), conducted a retrospective study of patients from a racially diverse, urban safety-net hospital with a diagnosis of ovarian torsion during a four-and-a-half-year period.
Older age, having had more children in the past, larger ovarian size on imaging, having a laparotomy (large surgical incision into the abdominal cavity) and having a gynecologic oncologist perform the surgery were significantly associated with a higher likelihood of oophorectomy in ovarian torsion cases. In contrast to prior studies on oophorectomy, patient race did not impact the likelihood of oophorectomy in this study.
According to the researchers, only 20 percent of the ovaries removed were actually necrotic, consistent with other studies that found that ovarian function could be preserved in 88 to 100 percent of ovarian torsion cases, and none contained cancer.
This suggests that surgeon ability to diagnose ovarian necrosis based on appearance of the ovary as the indication for oophorectomy is poor."
Wendy Kuohung, MD, Corresponding Author, Associate Professor of Obstetrics & Gynecology, BUSM
The researchers believe there is need to increase awareness that ovarian preservation in premenopausal women is an option. "Understanding the clinical factors associated with a higher likelihood of oophorectomy in ovarian torsion cases may help to reduce unnecessary oophorectomies in the future and thus improve fertility and overall health of premenopausal women," added Kuohung, who also is a reproductive endocrinologist at Boston Medical Center.
These findings appear online in the Journal of Gynecologic Surgery.
Michelis, L.D., et al. (2020) Factors Associated with Oophorectomy in Patients with Suspected Ovarian Torsion. Journal of Gynecologic Surgery. doi.org/10.1089/gyn.2020.0087.