Ovarian torsion (or adnexal torsion) is a twisting of the ovary and/or fallopian tube on its vascular and ligamentous supports, blocking adequate blood flow to the ovary.
Ovarian torsion is a surgical emergency. Rapid diagnosis and intervention are necessary to preserve ovarian function where this is clinically appropriate and it is important to maintain fertility.
Most often seen in women of reproductive age; can occur during pregnancy. Also seen in infants, children, adolescents, and post-menopausal women.
Commonly presents with acute severe pelvic or abdominal pain, nausea, vomiting, and usually with a palpable abdominal mass. High clinical suspicion is necessary. Clinical presentation is often non-specific, with no absolute clinical profile.
Transvaginal ultrasound may show an enlarged ovary.
Definitive diagnosis is surgical. Laparoscopic surgery with detorsion is the preferred treatment to preserve normal ovarian function and fertility where this is clinically appropriate. Oophorectomy may be performed where this is preferable clinically and the patient does not wish to retain fertility.
Ovarian torsion is a twisting, or torsion, of the ovary around its ligamentous supports. This may result in loss of blood supply to both the ovary and the fallopian tube. When diagnosed, this condition is considered a surgical emergency. Therefore, reaching a correct diagnosis as quickly as possible is critical in order to prevent adverse events that may result in the loss of the ovary, fallopian tube, or both.
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
- ovarian neoplasm
- non-functional ovarian cyst
- para-ovarian cyst
- infertility treatment
- strenuous exercise
- sudden increased abdominal pressure
- polycystic ovary syndrome
1st investigations to order
- pregnancy test
- 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
Jackie Ross, BSc, MBBS, FRCOG
Consultant Gynaecologist and Clinical Lead
Early Pregnancy and Gynaecology Assessment Unit
King’s College Hospital NHS Foundation Trust
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.
JR declares that she has no competing interests.
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
Department of Obstetrics and Gynecology
Northeast Ohio Medical University
Chief of Gynecologic Oncology
Disclosures: SS declares that she has no competing interests.
Cecilia Bottomley, MBBChir, MD, MRCOG
Consultant Gynaecologist and Clinical Lead for Gynaecology Governance
University College London Hospitals NHS Foundation Trust
CB declares that she has no competing interests.
Section Editor, BMJ Best Practice
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.
Lead Section Editor, BMJ Best Practice
RW declares that she has no competing interests.
Comorbidities Editor, BMJ Best Practice
AS declares that she has no competing interests.
Drug Editor, BMJ Best Practice
AM declares that he has no competing interests.
- Ectopic pregnancy
- Mittelschmerz due to ruptured graafian (dominant) follicle
- Imaging in gynecological disease: clinical and ultrasound characteristics of adnexal torsion
- Guideline for the management of ovarian cysts in children and adolescents
Ovarian torsionMore Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer