Ovarian torsion

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 intermittent or fluctuating nonspecific pain in the lower abdomen, along with a pelvic mass.[1]American College of Obstetricians and Gynecologists. Adnexal torsion in adolescents: ACOG committee opinion no, 783. Obstet Gynecol. 2019 Aug;134(2):e56-63. https://journals.lww.com/greenjournal/fulltext/2019/08000/adnexal_torsion_in_adolescents__acog_committee.45.aspx http://www.ncbi.nlm.nih.gov/pubmed/31348225?tool=bestpractice.com However, there is no absolute clinical profile, and diagnosis is therefore a challenge.[1]American College of Obstetricians and Gynecologists. Adnexal torsion in adolescents: ACOG committee opinion no, 783. Obstet Gynecol. 2019 Aug;134(2):e56-63. https://journals.lww.com/greenjournal/fulltext/2019/08000/adnexal_torsion_in_adolescents__acog_committee.45.aspx http://www.ncbi.nlm.nih.gov/pubmed/31348225?tool=bestpractice.com Intermittent pain; nausea and vomiting; pain radiating to the back, flank, and groin; a palpable mass; fever; and leukocytosis have all been associated with ovarian torsion.

In the neonatal period, ovarian torsion may present with feeding intolerance, vomiting, abdominal distention, and fussiness. Torsion of a paraovarian cyst or an isolated fallopian tube, although rare, is also possible.