Patient handout

Ovarian / adnexal torsion (time-critical surgical emergency)

PRODUCTION

1. Your condition

This handout is for ovarian / adnexal torsion (time-critical surgical emergency). Your care team identified this based on: sudden severe unilateral pelvic / lower abdominal pain (acog co 783, 2019).

Other reasons your team may use this plan: pelvic pain with nausea and vomiting (mimics ovarian torsion — acog co 783, 2019); tvus: enlarged ovary >5 cm, decreased / absent doppler flow, whirlpool sign, ovarian edema (acr appropriateness criteria); known ovarian mass / cyst (especially dermoid >5 cm or simple cyst >5 cm — acog co 783, 2019).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
Lactated Ringer solution	500-1000 mL IV bolus, then maintenance	IV	continuous	Pre-op resuscitation + maintenance; balanced crystalloid preferred (ACOG CO 783, 2019)
ondansetron	4 mg IV	IV	q8h PRN	Symptom control; non-sedating (ACOG CO 783, 2019)
morphine	0.1 mg/kg IV (typical 4-10 mg adult)	IV	q3-4h PRN	Severe acute pain; titrate to effect (ACOG CO 783, 2019)
fentanyl	25-100 mcg IV	IV	q5-15 min PRN	Short-acting, less histamine release; preferred in unstable patients (ACOG CO 783, 2019)
ketorolac	15-30 mg IV	IV	q6h PRN, max 5 days	Multimodal analgesia; avoid in renal impairment, bleeding risk, suspected pregnancy (ACOG CO 783, 2019)
acetaminophen	1 g IV/PO	IV/PO	q6h, max 4 g/day	Opioid-sparing; safe in pregnancy (ACOG CO 783, 2019)

Plan: Ovarian torsion — perioperative supportive care + surgical pathway (ACOG CO 783, 2019)

3. When to call your provider

Contact your care team if any of the following happen:

New severe pelvic pain, vomiting, syncope → ED for recurrent torsion evaluation (ACOG CO 783, 2019)
Pathology returns malignancy — refer gyn-onc; staging + adjuvant per histology (ACOG PB 234, 2021)
Pelvic ultrasound at 3 months shows non-viable ovary OR persistent mass — gynecology re-evaluation; consider re-imaging with MRI (ACOG CO 783, 2019)
Premature ovarian insufficiency markers (FSH > 25 mIU/mL on 2 occasions + amenorrhea / vasomotor symptoms) — refer REI / endocrinology for hormone replacement + fertility counseling (NASPAG 2020)
Recurrent torsion at any time — return to gynecology for oophoropexy consideration (ACOG CO 783, 2019)
Persistent psychosocial distress at 6-week or 3-month visit — referral to counseling / mental-health support (NASPAG 2020)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Sudden severe unilateral pelvic pain + N/V + adnexal mass on US even with preserved Doppler flow (ACOG CO 783, 2019)
Rebound, guarding, hypotension, tachycardia, or fever (ACOG CO 783, 2019)(life-threatening)
Pediatric or adolescent female with sudden severe unilateral pelvic pain +/- adnexal mass (NASPAG 2020)
Pregnant patient with suspected torsion (esp. first trimester or after IVF — ACOG CO 783, 2019)
Second or third torsion event in same patient (ACOG CO 783, 2019)
Adnexal mass with imaging features suggesting malignancy (solid components, papillary projections, ascites) or postmenopausal patient (ACOG CO 783, 2019)
Recent IVF / ovulation induction with bilateral enlarged ovaries and torsion features (ACOG CO 783, 2019)
> 6 hours from confirmed torsion diagnosis (imaging or clinical) to OR — ovary salvage rate drops to < 30 % beyond 24 h despite still-recommended detorsion attempt (Oelsner Hum Reprod 2003; Bouguizane 2003; Anders 2005)
Simultaneous bilateral adnexal torsion — rare but with severe fertility consequence; pediatric and IVF / OHSS populations at higher relative risk (ACOG CO 783, 2019)(life-threatening)

5. Follow-up

Outpatient gyn 1-2 wk; pathology review; reproductive counselling; recurrence-prevention discussion (oophoropexy decision — ACOG CO 783, 2019); contraception counselling if pregnancy not desired

6. Sources

Guideline: ACOG Committee Opinion 783 (2019, reaff 2023) — Adnexal torsion in adolescents and reproductive-age women + ACOG Practice Bulletin 234 (2021) — Management of Adnexal Masses + ACR Appropriateness Criteria — Acute Pelvic Pain in the Reproductive Age Group (most recent revision) + NASPAG 2020 + AAP pediatric ovary-preservation consensus + Oelsner Hum Reprod 2003 + Bouguizane 2003 + Anders Arch Pediatr Adolesc Med 2005 + Vijayaraghavan J Ultrasound Med 2004 (whirlpool sign) + SOGC Ovarian Torsion CPG (verify)