Ovarian torsion is the most common reason for emergency removal of an ovary. After opening an acute surgical abdomen, you find the strangulation of one ovary (usually involves the fallopian tube as well) due to a twisting of the blood supply to these structures.

Place a clamp of any appropriate size or type across the twisted pedicle, and excise the affected ovary and tube. Suture the pedicle to secure the blood supply and then close the abdomen. The only important structure close to where you will be clamping and suturing is the ureter. This may be avoided by keeping the clamp and suture within the twisted pedicle itself and not going too deep below the twisted portion.

Don’t try to untwist the ovary or tube since you may release clot or cellular toxins into the general circulation. In operational settings, when ovarian torsion is encountered, the ovary and all affected tissue should be simply removed.

Drains are not necessary. Watch for signs of metabolic acidosis during the recovery as the necrotic tissue may have released enough tissue toxins to cause this problem.

Back to Obstetrics and Gynecology