Ovarian Torsion Clinical Pathway

Pathway Background and Objectives

Ovarian torsion is the complete or partial rotation of the ovary on its pedicle, leading to ischemia and potential loss of the ovary. Early diagnosis can be challenging as ovarian torsion accounts for only 3% of acute abdominal pain in females, and can mimic other more common conditions. While Doppler ultrasound is an important part of the initial workup, normal ovarian appearance and Doppler flow do not exclude the possibility of torsion. Prompt surgical treatment with operative de-torsion is the key factor leading to ovarian salvage.

The objectives of this pathway are to:

Implement a systematic approach to manage patients presenting with ovarian torsion
Achieve prompt recognition and rapid definitive surgical treatment for patients with this condition
Outline consistent discharge criteria and ensure appropriate outpatient follow-up for patients with ovarian torsion

Algorithm Educational Module

Key References

Guthrie BD, Alder MD, Powell EC. Incidence and trends of pediatric ovarian torsion hospitalizations in the United States, 2000-2006. 2010 Mar;125(3):532-8.
Campbell BT, Austin DM, Kahn O, McCann MC, Lerer TJ, Lee K, Thaker S, Herbst KW, Rader CM. Current trends in the surgical treatment of pediatric ovarian torsion: we can do better. J Pediatr Surg. 2015 Aug;50(8):1374-7.
Dasgupta R, et al. Ovarian torsion in pediatric and adolescent patients: A systematic review. J Pediatr Surg. 2018 Jul;53(7):1387-1391.

Disclaimer

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.