Ovarian torsion; what is it, can the ovaries be preserved, is it possible to get pregnant afterwards?

Ovarian torsion gives symptoms with full rotation of the ovarian vessels on which it is fed and usually causes ischemia. Often, the tube is also twisted together with the ovary, and its nutrition is impaired. It is one of the most common gynecological emergencies and prompt diagnosis is important to preserve ovarian and/or tubal function and prevent other associated morbidities. Ovarian torsion occurs in women of all ages, but most cases occur in patients of reproductive age. The primary risk factor for ovarian torsion is ovarian mass, especially when the ovary is greater than 5 cm in diameter. The classic manifestation of ovarian torsion is the onset of acute pelvic pain, often with nausea and vomiting, in a patient with an adnexal mass. In addition to abdominal and gynecological examination, the most important imaging method that contributes to the evaluation is often ultrasound. Absence of Doppler currents on USG in suspected ovarian torsion, edematous monitoring of the ovary and a fluid around it bring us closer to the diagnosis of torsion. Definitive diagnosis of ovarian torsion is made by direct visualization of a rotated ovary during surgical evaluation. The main surgical approach is laparoscopic, that is, with the closed method, in favor of the patient. For most patients of reproductive age, we recommend detorsion and preservation of the ovary rather than removal of the ovaries, even in the case of a darkened, enlarged ovary. This approach provides a possible improvement in fertility outcomes. If there is a benign mass/cyst that sometimes accompanies ovarian torsion, the cyst is removed with detorsion. Torsioned ovary removal may be required in the presence of suspected cancer and in patients over the age of 40 who have completed their reproduction, and in patients who have been fed for a long time and have necrotic changes. For premenarchal patients with ovarian torsion and normal ovary, after detorsioning instead of detorsion alone, we additionally fix the ovary, which we call oophoropexy, so that the ovarian tissue does not return again. Patients with normal ovaries may be at higher risk of recurrent torsion than those with an ovarian mass.