History and exam
Key diagnostic factors
common
pelvic or abdominal pain
Acute pelvic or lower abdominal pain.
Pain may be intermittent or constant, chronic or acute. May be localised to either side or diffuse, or may radiate to the back, flank, or groin (which may resemble renal colic).
nausea, vomiting, or diarrhoea
Non-specific but common presenting symptom of ovarian torsion.
abdominal/pelvic tenderness
Location may be localised, diffuse, or adnexal.
palpable adnexal mass
May be felt on examination in roughly 43% to 53% of cases due to enlarged adnexa.[49]
presence of risk factors
Risk factors include previous ovarian torsion, pregnancy, ovarian hyperstimulation, polycystic ovary syndrome, and benign or malignant ovarian cysts.
Other diagnostic factors
common
feeding intolerance, vomiting, abdominal distension, and fussiness (neonates)
In the neonatal period, ovarian torsion may present a diagnostic challenge, due to the neonate's inability to communicate.
uncommon
strenuous exercise
Sudden physical movements may cause an increase in abdominal pressure and push the ovary to rotate on its pedicle.[23]
peritoneal signs
In women undergoing laparoscopy for suspected ovarian torsion, rebound has been reported in 14% of cases, and guarding reported in 18% of cases.[27]
cervical motion tenderness
Uncommon, but may be a presenting sign.
fever
Uncommon, but may be a presenting sign.
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