EP25.09: Sonographic predictors of ischemic ovary in ovarian torsion

Ovarian torsion is a gynecologic emergency, accounting for 3% of acute lower abdominal pain referrals to emergency room. Ultrasound is the major imaging tool for diagnosis. Sonographic signs characterising ovarian torsion have been described however, reports regarding sonographic predictors for level of ischemia are scarce. We aimed to investigate whether sonographic parameters can predict severity of ischemia using a sonographic-based scoring method. A retrospective study design included women who presented at a tertiary medical centre between 2010 and 2021 with lower abdominal pain and were subsequently diagnosed laparoscopically with adnexal torsion. We compared sonographic characteristics in women diagnosed with an ischemic ovary during surgery with those diagnosed with a non-ischemic ovary. Ischemia was defined by colour of the ovary in torsion as describe at operation (pink=non-ischemic while bluish to black as ischemic). Of 228 women with surgically proven adnexal torsion, 169 had ischemic ovarian and 59 had ovarian torsion without ischemia. The ischemic group was characterised by statistically significant edema (P Value-0.011), abnormal flow on Doppler (P Value<0.001) and free fluid in Douglas (P Value-0.067) as detected on sonogram. The prediction model had an AUC of 74.8% (95% CI 0.626 - 0.870). Ultrasound examination plays a pivotal role in diagnosing adnexal torsion. We introduce a novel scoring method using sonographic markers to predict ovarian ischemia. Our findings might have clinical implications, enabling early identification of at-risk ischemic ovary contributing to prompt surgical intervention. Further validation and research of our scoring method are essential to optimise its clinical utility. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.