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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Ovarian torsion

Obstetrics and gynaecology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

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Torsion is a time-critical surgical diagnosis

Sudden or intermittent unilateral pelvic pain with nausea or vomiting, particularly with an ovarian mass, pregnancy or fertility treatment, may reflect progressive ovarian ischaemia even when blood tests or Doppler flow appear reassuring.

Action: Keep the patient nil by mouth, provide analgesia, obtain pregnancy testing and intravenous access, call senior gynaecology promptly and proceed to diagnostic laparoscopy when suspicion remains high without delaying for a perfect scan.

Synopsis

Recognise adnexal torsion despite imperfect tests, secure urgent operative assessment, and preserve ovarian function through timely detorsion and proportionate treatment of the underlying lesion.

  • Adnexal torsion is rotation of the ovary, often with the tube, around its vascular and ligamentous supports; venous and lymphatic obstruction precedes arterial compromise.
  • An ovarian mass is the commonest precipitant, but torsion can occur in a normal ovary, during pregnancy, postpartum or after ovarian stimulation.
  • Pain may be sudden, intermittent or less dramatic than expected; nausea and vomiting materially increase suspicion, while fever and inflammatory change may appear late.
  • Perform pregnancy testing and focused ultrasound, but understand the limitations: ovarian enlargement, stromal oedema, peripheral follicles, a twisted pedicle and reduced flow support torsion, whereas normal flow does not rule it out.
  • Diagnosis is ultimately surgical. High clinical probability requires urgent diagnostic laparoscopy and must not wait for out-of-hours imaging availability or serial laboratory deterioration.
  • In premenopausal patients, laparoscopic detorsion with ovarian preservation is preferred when feasible; dark or blue-black appearance alone poorly predicts recovery.
  • Treat a benign lead point with cystectomy when safe, or defer definitive cyst surgery if oedema and friability make tissue loss likely; send any removed tissue for histology.
  • Oophorectomy is reserved for unavoidable non-reconstructable tissue, strong malignancy concern or an individualised context where conservation is inappropriate, with consent and oncology planning where possible.

Key red flags

Abrupt severe unilateral lower abdominal pain with vomiting is the classic high-risk combination and needs immediate gynaecological assessment.

Recurrent short episodes can represent torsion and spontaneous detorsion; improvement does not make the next ischaemic episode safe.

Guarding, fever, persistent tachycardia or rising inflammatory markers may indicate prolonged ischaemia, necrosis or an alternative abdominal emergency.

A positive pregnancy test requires simultaneous exclusion of ectopic pregnancy; pregnancy also increases torsion risk through corpus-luteum and ovarian enlargement.

Normal arterial or venous Doppler flow cannot exclude torsion and should never be used alone to cancel urgent surgical review.

Investigation priorities

01
Urine or serum pregnancy testFirst step

Identify ectopic-pregnancy risk and adapt imaging, anaesthesia and corpus-luteum management.

Management branches

Immediate assessmentPrepare for surgery while testing

Sudden or intermittent unilateral pelvic pain with vomiting or an adnexal risk factor raises torsion concern.

  1. Use ABCDE, provide analgesia, establish pregnancy status and intravenous access, obtain targeted bloods and keep the patient nil by mouth.
  2. Call the acute gynaecology registrar and consultant early and arrange urgent pelvic ultrasound if it can occur without operative delay.
  3. Escalate directly to diagnostic laparoscopy when probability remains high despite normal bloods or preserved Doppler flow.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • BMJ: Recognition and initial management of ovarian torsion
  • The Obstetrician and Gynaecologist: Ovarian torsion modern management
  • NHS Borders: Ovarian cysts and masses management
  • NHS: Ovarian cyst

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom