Case history
Case history #1
An 18-year-old, gravida 0, para 0 woman is admitted with acute intermittent left-sided abdominal pain that began the day before. She says she has never had sexual intercourse and is on day 1 of her menstrual cycle. Past medical history was uneventful except for an appendectomy. On examination, no abdominal tenderness is elicited. However, a left adnexal mass is palpable and noted to be exquisitely tender.
Case history #2
A 37-year-old, gravida 1, para 1 woman presents with acute severe abdominal pain. The patient has no significant medical or surgical history. Pain is noted to be more severe on the right side.
Other presentations
The most common presentation is a sudden onset of colicky, severe pain in the lower abdomen, sometimes with a pelvic mass. The pain is typically fluctuating but may be constant.[1] However, there is no absolute clinical profile, and diagnosis is therefore a challenge.[1][2] Intermittent pain; nausea and vomiting; pain radiating to the back, flank, and groin (which may resemble renal colic); a mass that may or may not be palpable; fever; and leukocytosis have all been associated with ovarian torsion.
The presentation is similar in children, adolescents, and pregnant or non-pregnant adults. However, in the neonatal period, ovarian torsion may present with feeding intolerance, vomiting, abdominal distension, and fussiness. Torsion of a para-ovarian cyst or an isolated fallopian tube, although rare, is also possible. Para-ovarian cysts are more common in children with ovarian torsion than in adults.
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