Ovarian torsion: Assessing perfusion with the bivalve technique

(A) An enlarged ovary found torsed upon laparotomy demonstrated a dark, dusky appearance secondary to venous lymphatic congestion in the setting of continued arterial perfusion. The arrow denotes the torsed, enlarge, viable ovary, and the dashed arrow denotes the fallopian tube (viable).
(B) Following the bivalve technique, continued arterial perfusion is suggested by the red blood extruding into the cortex along with patches of improved duskiness following release of capsular pressure.
(C) A second bivalve incision demonstrates further improvement.
(D) The same ovary seen later in situ with normal appearance.