Ovarian torsion: a modern approach to management

Key content Ovarian torsion accounts for 2%–3% of gynaecological emergencies, yet with a 40% rate of pre‐surgical diagnosis on ultrasound, it continues to present a diagnostic challenge with a significant reliance on clinical presentation. Modern management has evolved to include conservative detorsion and cystectomy as the mainstay of treatment in view of fertility preservation; however, despite evidence that it is harmful and unnecessary, there is still a widespread view that oophorectomy is reasonable management. Oophoropexy is becoming more widely offered to prevent recurrence, yet there is no standardised technique. In this article, we aim to review current research evidence to present a modern update on diagnosis and management, including methods of oophoropexy and a review on the fertility outcomes in patients with ovarian torsion. Learning objectives To know how to diagnose ovarian torsion including clinical and ultrasound presentation. To learn updates on surgical management of ovarian torsion, including when and how to perform an oophoropexy. To understand implications on fertility of ovarian torsion and how to discuss this with a patient.