Ovary - Ovarian torsion 

Ovarian torsion may be defined as the partial or complete torsion of the ovary on its supporting ligaments that may in turn compromise the blood supply. If the fallopian tube is also involved then it is referred to as adnexal torsion. 
 
Risk factors 

• ovarian mass 

  • present in around 90% of cases of torsion 

  • makes torsion more likely to happen when the ovary is enlarged or heavier than usual - commonly due to a cyst or tumour 

• being of a reproductive age 

• pregnancy 

• ovarian hyperstimulation syndrome 

 
Features 

• usually the sudden onset of deep-seated colicky abdominal pain 

  • there is often a history of recent vigorous activity or a sudden increase in abdominal pressure 

  • often unilateral but some women have diffuse lower abdominal pain 

• associated with vomiting and distress 

• fever may be seen in a minority (possibly secondary to adnexal necrosis) 

• vaginal examination may reveal adnexial tenderness 

 
Ultrasound may show free fluid or a whirlpool sign. 
 
Laparoscopy is usually both diagnostic and therapeutic.