Urgent management of suspected ovarian torsion involves prompt clinical assessment and rapid surgical intervention to preserve ovarian function and prevent complications.
Initially, the patient should undergo a thorough clinical evaluation focusing on sudden onset unilateral lower abdominal pain, nausea, and vomiting, which are common presenting features. Immediate pelvic ultrasound with Doppler flow studies is essential to assess ovarian blood flow and identify adnexal masses or torsion signs, although normal Doppler flow does not exclude torsion NICE CG122 Dawood et al. 2021.
Once ovarian torsion is suspected clinically and radiologically, urgent referral to gynaecology for surgical exploration is mandatory. Surgery, preferably laparoscopic detorsion, should be performed as soon as possible to restore blood flow and preserve ovarian viability. Delays increase the risk of ovarian necrosis and loss NICE CG122 Dawood et al. 2021.
During surgery, the ovary should be untwisted even if it appears ischemic, as recovery is possible. Oophorectomy is reserved for cases where the ovary is non-viable or malignancy is suspected. Postoperative monitoring and follow-up imaging may be required to assess ovarian function NICE CG122 Dawood et al. 2021.
In summary, the urgent management steps are: rapid clinical and ultrasound assessment, immediate gynaecology referral, and prompt surgical detorsion to maximize ovarian salvage NICE CG122 Dawood et al. 2021.