Summary
Definition
History and exam
Key diagnostic factors
- pelvic or abdominal pain
- nausea, vomiting, or diarrhoea
- abdominal/pelvic tenderness
- palpable adnexal mass
- presence of risk factors
Other diagnostic factors
- feeding intolerance, vomiting, abdominal distension, and fussiness (neonates)
- strenuous exercise
- peritoneal signs
- cervical motion tenderness
- fever
Risk factors
- ovarian neoplasm
- non-functional ovarian cyst
- para-ovarian cyst
- hydrosalpinx
- pregnancy
- infertility treatment
- strenuous exercise
- sudden increased abdominal pressure
- polycystic ovary syndrome
Diagnostic investigations
1st investigations to order
- pregnancy test
- urinalysis
- FBC
- group and save
- sickle cell test
- C-reactive protein (CRP)
- transvaginal ultrasound
- abdominal or transrectal ultrasound
- Doppler flow
- PCR, nucleic acid amplification test, or cervical culture
- surgical visualisation
Investigations to consider
- CT abdomen/pelvis
- MRI abdomen/pelvis
Treatment algorithm
all patients
Contributors
Expert advisers
Jackie Ross, BSc, MBBS, FRCOG
Consultant Gynaecologist and Clinical Lead
Early Pregnancy and Gynaecology Assessment Unit
King’s College Hospital NHS Foundation Trust
London
UK
Biography
JR is Vice Chair of the Association of Early Pregnancy Units and a medical advisor to the Ectopic Pregnancy Trust. She is also a course organiser for the Royal College of Obstetricians and Gynaecologists (RCOG) advanced skills training in Early Pregnancy and Acute Gynaecology, and South London RCOG ultrasound training co-ordinator for Gynaecology.
Disclosures
JR declares that she has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:
Dr Sareena Singh, MD, FACOG
Assistant Professor
Department of Obstetrics and Gynecology
Northeast Ohio Medical University
Rootstown
Chief of Gynecologic Oncology
Aultman Hospital
Canton
OH
Disclosures: SS declares that she has no competing interests.
Peer reviewers
Cecilia Bottomley, MBBChir, MD, MRCOG
Consultant Gynaecologist and Clinical Lead for Gynaecology Governance
University College London Hospitals NHS Foundation Trust
London
UK
Disclosures
CB declares that she has no competing interests.
Editors
Susan Mayor
Section Editor, BMJ Best Practice
Disclosures
SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.
Rachel Wheeler
Lead Section Editor, BMJ Best Practice
Disclosures
RW declares that she has no competing interests.
Annabel Sidwell
Comorbidities Editor, BMJ Best Practice
Disclosures
AS declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
Differentials
- Ectopic pregnancy
- Mittelschmerz due to ruptured graafian (dominant) follicle
- Urolithiasis
More DifferentialsGuidelines
- Imaging in gynecological disease: clinical and ultrasound characteristics of adnexal torsion
- Guideline for the management of ovarian cysts in children and adolescents
More GuidelinesPatient leaflets
Ovarian torsion
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