[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Ovarian torsion [Conditions](https://durgical.com/en/conditions/) · [Pelvis](https://durgical.com/en/anatomy/region/pelvis/) # Ovarian torsion Ovarian torsion is the twisting of an ovary on its supports, cutting off its blood flow; it causes sudden severe pelvic pain and is a surgical emergency. Updated 2026-10-29 ## Structures involved Tap one to see what it is and open it in 3D. - [Ovaries](https://durgical.com/en/anatomy/ovary/) - [Suspensory ligament of ovary](https://durgical.com/en/anatomy/suspensory-ligament-of-ovary/) - [Ovarian ligament](https://durgical.com/en/anatomy/proper-ovarian-ligament/) - [Ovarian artery](https://durgical.com/en/anatomy/ovarian-artery/) - [Uterine tubes](https://durgical.com/en/anatomy/uterine-tube/) - [Mesovarium](https://durgical.com/en/anatomy/mesovarium/) - [Broad ligament](https://durgical.com/en/anatomy/broad-ligament-of-uterus/) ## In the clinical exam - [McBurney point](https://durgical.com/en/clinical-exam/mcburney-point/) - [Rovsing, psoas and obturator signs](https://durgical.com/en/clinical-exam/rovsing-psoas-and-obturator-signs/) ## In physiology - [Oogenesis, follicles and ovulation](https://durgical.com/en/physiology/oogenesis-follicles-and-ovulation/) ## Why it happens - [Infarction: red vs white, and what decides the damage](https://durgical.com/en/general-pathology/infarction-red-vs-white-and-what-decides-the-damage/) - [Hypoxia, ischemia and reperfusion injury](https://durgical.com/en/general-pathology/hypoxia-ischemia-and-reperfusion-injury/) - [Ovary: follicles, ovulation and corpus luteum](https://durgical.com/en/histology/ovary-follicles-ovulation-and-corpus-luteum/) ## What it is Partial or complete twisting of the ovary on its supporting ligaments, often together with the [uterine tube](https://durgical.com/en/anatomy/uterine-tube/) (adnexal torsion). It cuts off venous and then arterial flow and is a gynaecological surgical emergency. ## Who gets it Seen mostly in women of reproductive age, but also in girls and in pregnancy. It is a classic cause of acute pelvic pain to consider alongside appendicitis and ectopic pregnancy in emergency departments in Colombia and elsewhere. ## Causes - An enlarged ovary that acts as a pivot: functional cyst, dermoid cyst (mature teratoma) or other benign mass - Ovarian enlargement after ovulation induction (ovarian hyperstimulation) - Long or lax supporting ligaments, especially in children, who can twist a normal ovary ## Risk factors - Ovarian mass or cyst, mainly benign and of moderate size (larger masses are often cited as a risk) - Pregnancy, especially the first trimester - Fertility treatment - Previous torsion - Polycystic-appearing ovaries ## Pathophysiology The ovary rotates around the suspensory ligament (with the ovarian vessels) and the [ovarian ligament](https://durgical.com/en/anatomy/proper-ovarian-ligament/). Thin-walled veins and lymphatics collapse first, so the ovary swells with oedema; arterial inflow then fails and ischaemia and necrosis follow. The right side is affected more often, perhaps because the [sigmoid colon](https://durgical.com/en/anatomy/sigmoid-colon/) limits movement on the left. ## Classification - Partial or intermittent (pain that comes and goes) or complete - Isolated ovarian, isolated tubal or combined adnexal torsion - With a normal ovary (more typical in children) or with an ovarian mass ## Symptoms and signs - Sudden, severe, one-sided lower abdominal or pelvic pain, sometimes after exercise or a change in position - Nausea and vomiting, common - Earlier episodes of similar pain that settled (intermittent torsion) - Tender adnexal mass on examination in some patients - Low-grade fever if necrosis develops ## Red flags - Sudden pelvic pain with vomiting in a woman with a known ovarian cyst - Peritoneal signs, fever or rising white cell count, suggesting necrosis - Pain in pregnancy or after fertility treatment ## Diagnosis **Clinical** Suspected from sudden pelvic pain, vomiting and an adnexal mass. Signs are often non-specific, so a low threshold for surgical review is usual. The diagnosis is confirmed at surgery. **Tests** Pregnancy test (hCG) to exclude ectopic pregnancy; complete blood count; urinalysis. Tumour markers only when a mass looks suspicious. **Imaging** Pelvic ultrasound with Doppler: enlarged, oedematous [ovary](https://durgical.com/en/anatomy/ovary/), peripheral follicles, an underlying mass, free fluid or a twisted pedicle (whirlpool sign). Normal Doppler flow does not rule torsion out. CT or MRI if the picture is unclear. ## Differential diagnosis - Ectopic pregnancy - Ruptured or haemorrhagic ovarian cyst - Acute appendicitis - Pelvic inflammatory disease or tubo-ovarian abscess - Ureteric colic ([kidney](https://durgical.com/en/anatomy/kidney/) stones) ## Goal of treatment Untwist the adnexa quickly to save the ovary and fertility, and treat the underlying mass. ## Treatment **Acute** Analgesia, antiemetics and intravenous fluids while emergency surgery is arranged. **Surgical** Laparoscopic detorsion; the ovary is usually preserved even if it looks dark, because most recover function. **Surgical** Cystectomy for the underlying cyst; oophorectomy only if the ovary is clearly necrotic or a malignancy is suspected, more often after menopause. **Follow-up** Follow-up ultrasound to check the ovary and any remaining mass; oophoropexy is considered in selected recurrent cases. ## Complications - Loss of the ovary from necrosis - Infection or peritonitis from a necrotic adnexa - Reduced ovarian reserve - Recurrent torsion - Pregnancy loss when torsion occurs in pregnancy ## Prognosis With early detorsion most ovaries recover function. Delayed diagnosis increases the chance of losing the ovary. ## Test yourself Think of the answer, then tap the question to see it. ## Which vessels are compressed first in ovarian torsion? The veins and lymphatics, causing oedema and enlargement before the arterial supply fails. ## Does normal Doppler flow on ultrasound exclude ovarian torsion? No. Flow can be present, especially in partial or intermittent torsion; clinical suspicion leads to surgery. ## Is a dark, congested ovary removed at surgery for torsion? Usually not. Detorsion and preservation are preferred because most ovaries recover function. ## Which test is done first in any woman of reproductive age with acute pelvic pain? A pregnancy test, to exclude ectopic pregnancy. ## What is the most common predisposing factor for ovarian torsion in adults? An enlarged ovary from a benign cyst or mass, such as a dermoid cyst or a functional cyst. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/ovarian-torsion/) ## Related conditions - [Ovarian cyst](https://durgical.com/en/conditions/ovarian-cyst/) - [Ectopic pregnancy](https://durgical.com/en/conditions/ectopic-pregnancy/) - [Acute appendicitis](https://durgical.com/en/conditions/acute-appendicitis/) - [Pelvic inflammatory disease](https://durgical.com/en/conditions/pelvic-inflammatory-disease/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Ovarian Torsion](https://www.ncbi.nlm.nih.gov/books/NBK560675/) (StatPearls (NCBI Bookshelf), 2023). [← All conditions](https://durgical.com/en/conditions/) ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/conditions/ovarian-torsion/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/ovarian-torsion/