Detorsion

Detorsion is the untwisting of a torsed structure to restore normal anatomy and blood flow. It can be spontaneous or achieved manually or surgically. In clinical practice detorsion is most often discussed in relation to torsion of reproductive organs and to intestinal volvulus, but various tissues can be affected by torsion and may require detorsion.

In testicular torsion, detorsion may be attempted manually in the emergency setting to relieve ischemia while arranging definitive surgical care. The procedure is typically performed by rotating the testicle in the direction opposite to the presumed twist. If perfusion improves, the patient still requires urgent surgical exploration to assess viability and to perform orchiopexy, which fixes the testis to prevent recurrence. Manual detorsion is not a substitute for definitive surgery and may not always succeed.

In ovarian torsion, detorsion can be performed, especially in children and young women, to preserve ovarian tissue. Laparoscopic detorsion is common and may be followed by fixation (oophoropexy) or observation, depending on viability. If the ovary appears necrotic, removal may be considered, though preservation is often attempted when feasible.

For intestinal torsion or volvulus, detorsion is a component of emergent surgical management. Detorsion may relieve obstruction and restore perfusion, but ischemic injury or necrosis may necessitate resection of nonviable bowel. Recurrent torsion risk varies by location and underlying anatomy.

Complications of detorsion include reperfusion injury and, in some cases, retorsion if tissues lose stability. Prompt recognition and management are critical to optimize outcomes.