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Ovarian torsion (OT), a critical gynecological emergency caused by ovarian twisting and vascular compromise, risks necrosis without prompt intervention. This study evaluated dual-modal photoacoustic/ultrasound imaging for early detection and chronic hypoxia monitoring in OT. Rat models of complete/partial OT were established, with photoacoustic imaging (PAI) tracking tissue oxygen saturation (sO₂) over time, compared to color Doppler parameters (color pixel density [CPD]) and spectral Doppler parameters (peak systolic velocity [PSV], resistance index [RI]). In short-term (6-hour) torsion, PAI and CPD showed similar declining trends, but PAI provided superior sO₂ quantification. In long-term models, PAI detected significant sO₂ reductions at 12 and 24 h, whereas CPD declined only within the first 12 h, highlighting PAI’s enhanced accuracy for hypoxia assessment during the 12–24 h window. Histological analysis confirmed that PAI-measured hypoxia correlated with tissue injury severity. These findings demonstrate PAI’s reliability in evaluating hypoxia progression and tissue damage, facilitating precise early diagnosis and time-sensitive monitoring in prolonged OT. Combining ultrasound with PAI offers a more effective diagnostic tool for assessing OT progression, particularly in guiding timely interventions for long-term torsion.

We aim to present two rare cases of ovarian torsion immediately following controlled ovarian hyperstimulation and their prolonged recovery state at an academic fertility center. Patient 1 is a 38-year-old nulligravid woman with a history of prior right oophorectomy and patient 2 is a 37-year-old nulligravid woman with a previous left oophorectomy. The main objective of our paper is to characterize the recovery time after ovarian detorsion surgery. These case reports highlight that ovarian torsion after controlled ovarian hyperstimulation may be associated with prolonged systemic symptoms including increased abdominal pain, persistent low-grade fevers, and mild leukocytosis for several weeks following laparoscopic ovarian de-torsion. A proposed mechanism for this extended inflammatory state could be due to higher levels of luteinizing hormone surge activating Phospholipase C-Protein Kinase C pathway and vascular endothelial growth factors involved in follicular growth and luteinization.

Objective This study aimed to compare the clinical characteristics and surgical and histological outcomes of premenopausal and postmenopausal patients with adnexal torsion. Methods The electronic medical records of 278 patients with adnexal torsion proven by surgery were retrospectively reviewed from January 2012 to November 2023 in our hospital. The patients were divided into two groups (premenopausal and postmenopausal). Results The study included 226 (81.3%) premenopausal patients and 52 (18.7%) postmenopausal patients. The incidence of the most common symptoms (i.e., abdominal pain, nausea and/or vomiting) was not different between the two groups. However, the postmenopausal group had a longer interval from the onset of pain to admission, a larger size of adnexal mass, a longer operation time, more blood loss, and a longer hospital stay than the premenopausal group. Regarding the procedure, the premenopausal group underwent more conservative procedures than the postmenopausal group. The most common pathological findings in the two groups were benign tumors and tubal pathology The malignancy rate was similar in the two groups. Conclusions Premenopausal and postmenopausal women with adnexal torsion had similar main symptoms, such as abdominal pain and nausea and vomiting. However, the surgical and histological outcomes varied between these groups of women.

IntroductionAdnexal torsion is a gynaecological emergency in which prompt diagnosis and management are critical to preserving ovarian function. However, the clinical presentation is often non-specific, and diagnosis primarily relies on pelvic ultrasound, a modality with limited sensitivity that can lead to misdiagnosis and unnecessary surgery. Contrast-enhanced ultrasound (CEUS) has emerged as a promising imaging technique that may enhance diagnostic accuracy by better characterising adnexal vascularisation.The aim of this study is to assess whether the addition of CEUS to standard diagnostic procedures can reduce the rate of unnecessary emergency surgeries. Specifically, we compare two diagnostic strategies in cases of high clinical suspicion of adnexal torsion: the current standard approach versus an experimental strategy incorporating CEUS. The primary outcome is the rate of inappropriate surgical interventions, defined as emergency surgery performed within 6 hours without intraoperative confirmation of torsion.Methods and analysisThis is a prospective, open-label, multicentre, randomised (1:1), controlled, superiority trial. A total of 256 women presenting with a high clinical suspicion of adnexal torsion will be enrolled over a period of 36 months. Participants will be randomly assigned to either the standard diagnostic strategy or an experimental strategy that includes CEUS. The primary endpoint is the proportion of emergency surgical procedures (performed within 6 hours of hospital admission) in which adnexal torsion is not confirmed.Ethics and disseminationThe study was approved by the French Ethics Committee, the CPP (Comité de Protection des Personnes) on 28 October 2024. The results of this study will be published in peer-reviewed journals and presented at relevant national and international conferences. The ethical approval number from the CPP is 6115.Registration numberNCT06677554; 2024-511720-13-00.

Ovarian torsion (OT) is a rare gynaecological emergency that requires a prompt diagnosis for optimal patient management. To determine whether there were any biomarkers suitable for the non-invasive detection of OT, two independent reviewers performed systematic searches of five literature databases (PubMed, Medline, Scopus, Cochrane, and CINAHL) from inception until October 1st, 2023. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, the search included patients with OT that had quantified biomarker expression with no age, geographical location, publication date, language, or setting restrictions. Articles were excluded if OT was found incidentally, was based on qualitative analyses, or were not primary research articles. Full texts of 23 selected articles were assessed for risk of bias and quality assurance using a modified Newcastle–Ottawa Scale (NOS) for clinical studies and SYRCLE’s risk of bias tool for the assessment of pre-clinical (animal) studies. A total of 11 articles described studies on animals and all described serum biomarkers comparing results between OT versus a sham operation, a control group, or readings before and after OT. Ischaemia-modified albumhumin (IMA), serum D-dimer (s-DD), heat shock protein-70 (hsp-70), Pentraxin-3 (PTX3), and c-reactive protein (CRP) each showed the most promise, with p-values for the difference between OT and control groups achieving ≤ 0.001. In studies of humans, the biomarkers ranged from 16.4 to 92.3% sensitivity and 77–100% specificity. The most promising biomarkers for the early prediction of OT in patients included s-DD, interleukin-6 (IL-6), IMA, and tumour necrosis factor-alpha (TNF-α). Signal peptide, CUB domain, and EGF-like domain-containing 1 (SCUBE1) had a high specificity at 93.3%, second only to s-DD and a positive likelihood ratio (LR) > 10. IMA was the only other biomarker that also had a positive LR > 10, making it a promising diagnostic biomarker. The studies identified by this systematic literature review each analysed small patient groups but IMA, DD, and SCUBE1 nevertheless showed promise as serum biomarkers with a pooled LR > 10. However, further well-designed studies are needed to identify and evaluate individual markers or diagnostic panels to help clinicians manage this important organ-threatening condition.

Background Approximately 50% of isolated fallopian tube torsion cases and 5%-10% of tubo-ovarian torsion cases involve an ipsilateral paraovarian cyst. This study aimed to describe the clinical features of paraovarian cyst torsion including isolated fallopian tube torsion and tubo-ovarian torsion and to identify factors associated with delayed surgical intervention. Methods In this retrospective cohort study, we included adult women with surgically confirmed adnexal torsion and a coexisting ipsilateral paraovarian cyst at Peking University Third Hospital between January 2012 and December 2024. Group differences were analysed using independent samples t-tests, Mann–Whitney U tests and chi-square or Fisher’s exact tests. Multiple comparisons of clinical features were adjusted using the Benjamini–Hochberg method with a pre-specified false discovery rate threshold of 0.10. Logistic regression was performed to identify factors associated with a surgical decision-making interval exceeding 12 h after emergency department presentation. Results This study included 142 patients, with 66.2% diagnosed with isolated fallopian tube torsion and 33.8% with tubo-ovarian torsion. The mean diameter of paraovarian cysts was significantly larger in the tubo-ovarian torsion group than in the isolated fallopian tube torsion group (7.4 [5.9, 9.4] vs. 5.3 [4.4, 6.2] cm, q < 0.001). Among patients presenting with acute abdominal pain, the tubo-ovarian torsion group had a higher incidence of identifiable precipitating factors (OR = 3.61, 95%CI: 1.48–8.82, q = 0.040). This group also showed a trend toward a higher incidence of abdominal tenderness (OR = 2.33, 95% CI: 1.01–5.39, q = 0.075) and gastrointestinal symptoms such as nausea and/or vomiting (q = 0.060). However, no significant differences were observed in other pain-related characteristics, including pain severity and radiation patterns. Delayed surgical decision-making (> 12 h) occurred at more than 2.4 times the rate in the isolated fallopian tube torsion group (31.5% vs. 13.0%), though this association was of borderline statistical significance (q = 0.060). Logistic regression identified a paraovarian cyst diameter ≤ 6 cm, along with white blood cell count less than 10 × 10 9 /L, as independent factors associated with surgical decision-making duration exceeding 12 h. Conclusions Patients with isolated fallopian tube torsion complicating a paraovarian cyst typically present with smaller cysts and subtler clinical manifestations. Smaller paraovarian cyst diameter and lower white blood cell count were associated with delayed surgical intervention.

Massive ovarian oedema (MOE) is a rare benign condition that can mimic ovarian neoplasms and lead to unnecessary oophorectomy. It is typically caused by impaired venous and lymphatic drainage secondary to partial or intermittent ovarian torsion, with preserved arterial inflow resulting in stromal oedema and maintained follicular viability. We report a woman in her late 20s presenting with intermittent mild lower abdominal pain and infertility. Ultrasound imaging suggested a solid ovarian mass; however, MRI demonstrated features consistent with a torsion–detorsion sequence, including heterogeneous stroma and peripherally displaced follicles. Laparoscopy confirmed adnexal torsion with a markedly enlarged but viable ovary. Detorsion and controlled stromal decompression were performed, followed by ligament-based ovariopexy using the Hot-Dog-in-a-Bun technique to reduce the risk of recurrence while preserving vascular integrity. Follow-up demonstrated complete resolution of ovarian enlargement and restoration of normal morphology. This case highlights the importance of recognising MOE and supports conservative laparoscopic management to avoid unnecessary ovarian loss in reproductive-age women.

Dermoid cyst or mature cystic teratoma is the most common ovarian germ cell tumor. Clinical diagnosis is not easy. The acute abdominal pain associated with ovarian dermoid cysts usually involves adnexal torsion. Preoperative diagnosis of adnexal torsion with dermoid ovarian cyst can be based on pelvic imaging combined with clinical findings. Treatment is surgical and should be applied without delay. Cystectomy is the treatment of choice for the management of dermoid ovarian cysts that have undergone torsion and maintain adequate blood supply. Our case report concerns the emergency surgical intervention of a patient with right adnexal torsion and the presence of a large dermoid cyst. The patient came to the Emergency Department of our hospital with symptoms of an acute abdomen. Ultrasound confirmed the diagnosis of adnexal torsion with the presence of a mature cystic ovarian teratoma, and laparotomy with cystectomy was performed. Histological examination of the surgical specimen confirmed the diagnosis of twisted ovarian dermoid cyst. At this point, we must emphasize the crucial contribution of transabdominal pelvic ultrasound in the management of mature cystic ovarian teratomas accompanied by complete adnexal torsion. Early diagnosis and immediate surgical intervention in young patients who wish to preserve ovarian function in order to achieve future pregnancy are of major importance.

background: Delayed ovarian torsion management can lead to unnecessary oophorectomy and halving of a woman’s fertility potential. aims: To improve recognition and efficiency of ovarian torsion management at Waitematā by examining common presenting symptoms/signs and identifying areas of treatment delay. methods: An audit of all ovarian torsion cases at Waitematā over 24 months (01/05/2022–30/04/2024). results: Forty-five women had ovarian torsion, and 42 were premenopausal. Common presenting features included abdominal pain (100%), ovarian cysts (97.8%), nausea (82%) and vomiting (51%). Peritonism was rare (13.3%). Oophorectomy was performed in 26 cases (57.8%). Rates of oophorectomy increased with increasing time from symptom onset until presentation. The time from presentation until surgery (average of 28 hours) was longer than other tertiary centres, with delays largely arising from triage to ultrasound, and then while awaiting access to theatre. conclusions: Improving torsion recognition and expediting both imaging and surgery should reduce oophorectomy rates. Women presenting with symptomatic ovarian cysts without torsion should be adequately counselled on the risk of future torsion events and encouraged to seek acute medical attention for changes in symptoms. Additionally, more study is needed to determine if relying on computed tomography (CT) findings alone (e.g., presence of ovarian cysts more than 5cm) in the presence of symptoms suggestive of ovarian torsion can reduce time to diagnosis and improve surgical outcomes, compared to the commonly used CT followed by ultrasound.

Adnexal torsion is a rare cause of abdominal pain in middle childhood and, in general, the diagnosis is often delayed due to the lack of specificity of symptoms and imaging tests. We describe the case of a girl in middle childhood who came to the emergency department for pain in the right iliac fossa of approximately 15 hours of evolution associated with partial refusal of food intake and vomiting. The initial examination showed normal vital signs, a soft abdomen, pain on palpation in the lower region, but no signs of peritoneal irritation, a mild leucocytosis with no other signs of infection and the initial abdominal ultrasound showed no objective pathology. Finally, after clinical worsening and a repeat imaging test, she was diagnosed with right ovarian torsion.