Surgical approach is rarely needed in adnexal masses, surgery is planned for the masses above 8cm and fast-growing masses, masses including solid areas with high tumor markers.
Torsion of adnexal mass (development of gangrene by turning around its stem) are very important and should not be omitted in patients presenting abdominal pain. Probability of inaccurate diagnosis is high but delaying surgical interventions may result in loss of the ovary. Colicky abdominal pain, is a severe pain that comes and goes. Nausea, vomiting, high fever, leukocytosis (white blood cell increase) and acute abdominal findings (examination findings requiring surgical intervention) can be seen. Absence of blood flow in the ovaries on ultrasound is helpful in diagnosis, but torsion can be seen in cases where blood flow is present. Generally, ovary preserving surgery is preferred, adnexa is detortioned, expect the ovary return to its normal color and if there is cyst, it is removed. Rarely, removal of ovary may be required, too. Some studies show that gynecologists prefer it more frequently than pediatric surgeons since reproduction problems are most likely to occur in long term due to removal of ovary.