AKT · Obstetrics & gynaecology/Menstrual & benign gynae

Ovarian torsion

Twisting of ovary on its pedicle (ischaemia)

Overview

Twisting of the ovary (± fallopian tube) on its vascular pedicle, compromising blood supply — a gynaecological emergency. Usually involves an enlarged ovary (cyst/mass), causing sudden severe unilateral pain; the ovary is salvaged only by prompt detorsion.

Recognise

SUDDEN severe unilateral lower abdominal/pelvic pain, often with nausea/vomiting
Pain may be intermittent (partial/repeated torsion)
Tender adnexal mass; usually an underlying enlarged ovary/cyst

Red flags

Acute abdomen with an adnexal mass — emergency; delay risks ovarian loss

Differentials & how to tell them apart

Ectopic pregnancypositive βhCG with bleeding

Appendicitisright iliac fossa, migratory, GI symptoms

Ruptured/haemorrhagic cystsudden pain but Doppler flow preserved

PIDfever, discharge, bilateral, cervical motion tenderness

Investigations

Urgent transvaginal/pelvic USS with Doppler (reduced/absent flow, "whirlpool" sign, enlarged oedematous ovary). βhCG to exclude ectopic. Diagnosis often confirmed at laparoscopy.

Management

Urgent laparoscopic detorsion (preserve the ovary)

1Urgent surgical exploration (laparoscopy): detorse the ovary and remove any cyst; preserve viable ovarian tissue.Gate: Do not delay for imaging if clinical suspicion is high — the ovary becomes non-viable with time
2Oophorectomy only if the ovary is clearly necrotic.

Surgery (laparoscopic detorsion ± cystectomy) — urgent — preserve the ovary

Key points

Doppler flow can still be present in early/partial torsion — a normal Doppler does not exclude it. Clinical suspicion drives surgery.

Monitor & prognosis

Ovarian viability; recurrence.

Ovary salvageable with prompt detorsion.

Source: RCOG; emergency gynaecology