gynecology and obstetrics
Adnexal Torsion
Key Points
Adnexal torsion of the ovary and/or fallopian tube is a common gynecologic emergency; it usually occurs when the ovary is enlarged because of a mass or other problem. Torsion causes sudden, severe pelvic pain and sometimes nausea and vomiting; it may be preceded by days or occasionally weeks of intermittent, colicky pain, presumably resulting from intermittent torsion. Suspect adnexal torsion based on symptoms, pelvic tenderness during examination, and Doppler transvaginal ultrasonography with decreased or absent blood flow; follow immediately with exploratory surgery to confirm the diagnosis and treat it. If adnexal torsion is diagnosed, immediately attempt to salvage the ovary and fallopian tube by untwisting them via laparoscopy or laparotomy; if nonviable or necrotic tissue or an ovarian cyst or mass is present, surgical removal (salpingo-oophorectomy, cystectomy) is required. 