Summary
Definition
History and exam
Key diagnostic factors
- abdominal pain
- nausea, vomiting, or diarrhea
- abdominal/pelvic tenderness
- palpable adnexal mass
Other diagnostic factors
- feeding intolerance, vomiting, abdominal distention, and fussiness (neonates)
- strenuous exercise
- peritoneal signs
- cervical motion tenderness
- fever
Risk factors
- ovarian neoplasm
- ovarian cyst
- paraovarian cyst
- hydrosalpinx
- pregnancy
- infertility treatment
- strenuous exercise
- sudden increased abdominal pressure
Diagnostic tests
1st tests to order
- CBC
- pregnancy test
- transvaginal ultrasound with Doppler flow
- abdominal ultrasound
- genetic probe or cervical culture
- urinalysis
- surgical visualization
Tests to consider
- CT abdomen/pelvis
- MRI abdomen/pelvis
Treatment algorithm
all patients
Contributors
Authors
Dr Sareena Singh, MD, FACOG
Assistant Professor
Department of Obstetrics and Gynecology
Northeast Ohio Medical University
Rootstown
OH
Chief of Gynecologic Oncology
Aultman Hospital
Canton
OH
Disclosures
SS declares that she has no competing interests.
Acknowledgements
Dr Sareena Singh would like to gratefully acknowledge Dr Michael P. Hopkins, Dr Jay R. Patibandla, Dr John C. Nulsen, and Dr Vanessa N. Weitzman, the previous contributors to this topic.
Disclosures
MPH, JRP and JCN declare that they have no competing interests. VNW is an author of a reference cited in this topic.
Peer reviewers
Adam Magos, BSc, MB, BS, MD, FRCOG
Consultant Gynaecologist
University Department of Obstetrics and Gynaecology
Royal Free Hospital
London
UK
Disclosures
AM declares that he has no competing interests.
Joseph Sanfilippo, MD, MBA
Professor
Department of Obstetrics
Gynecology and Reproductive Sciences
Vice Chairman
Reproductive Sciences
Director
Division of Reproductive Endocrinology and Infertility
University of Pittsburgh
Pittsburgh
PA
Disclosures
JS declares that he has no competing interests.
Howard Sharp, MD
Associate Professor and Chief
General Division of Obstetrics and Gynecology
University of Utah School of Medicine
Salt Lake City
UT
Disclosures
HS has been reimbursed for attending and participating in conferences on pelvic varicosity pain syndrome by Cook Inc.
Differentials
- Ectopic pregnancy
- Pelvic inflammatory disease (PID)
- Appendicitis
More DifferentialsGuidelines
- Adnexal torsion in adolescents
- Guideline for the management of ovarian cysts in children and adolescents
More GuidelinesPatient information
Ovarian torsion
More Patient informationLog in or subscribe to access all of BMJ Best Practice
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