Purpose: To identify computed tomography (CT) findings for selection between conservative surgery and adnexectomy in patients of reproductive age with adnexal torsion. Methods: This retrospective study included 54 consecutive patients who underwent preoperative CT imaging before undergoing either conservative surgery or adnexectomy to treat adnexal torsion. Results: By multivariate analysis, CT finding of tubal thickening was significantly associated with the patients treated with adnexectomy (odds ratio. =. 7.6, P. =.008). Conclusion: Although the majority of patients of reproductive age with adnexal torsion can be treated with conservative surgery, patients who require adnexectomy tend to have a tubal thickening on CT.