Twisting of the ovary and/or fallopian tube on its vascular and ligamentous supports, blocking adequate blood flow to the ovary

Aetiology

Occurs due to 2 main reasons:

• Hypermobility of the ovary
• Adnexal mass, most commonly a dermoid cyst

Clinical features

Symptoms

• Severe non-specific lower abdominal and pelvic pain, either intermittent or sustained
• Nausea and vomiting

Signs

• Adnexal tenderness

Investigations

• Bloods: raised white cell count
• Ultrasound: initial imaging modality of choice
• CT: useful for ruling out ovarian torsion if a normal ovary/adnexa is seen on US

Management

• Urgent surgery
  • Most ovaries are not salvageable, in which case a salpingo-oophorectomy is required
  • In the case of a non-infarcted adnexa, surgical untwisting can be performed