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Ovarian torsion
Sudden one-sided pelvic pain with vomiting — the ovary is on the clock. Torsion is a clinical diagnosis supported by ultrasound. A normal Doppler doesn't exclude it. If the story fits, the gynaecologists need to look laparoscopically, and they will usually untwist and conserve the ovary. Built for revision, not live patient decisions.
Settle them, and check the basics
time-criticalRed flags — what each should make you think
Doppler flow on ultrasound doesn't rule out torsion: the ovary has a dual blood supply and twisting can be intermittent. If the history and examination fit, a normal scan shouldn't stop a gynaecology review and diagnostic laparoscopy.
First actions
- 🧪Pregnancy test
- 💊Analgesia + antiemetic
- IVIV access, bloods
- USSPelvic USS (TV + Doppler)
- NBMNil by mouth
- ☎Gynaecology urgently
Understand the patient
who · whatTypical features
- Sudden severe unilateral lower abdominal/pelvic pain, often during exertion, may be intermittent
- Nausea and vomiting are common
- Adnexal tenderness or mass; fever if necrotic
- Most have an ovarian mass (often a benign cyst or dermoid); also pregnancy and ovarian hyperstimulation
- Children and adolescents can tort normal ovaries
Treatment
- Urgent laparoscopy with detorsion
- The ovary is usually conserved even if it looks dusky — function often recovers
- Cystectomy if a cyst is present; oophorectomy only if clearly necrotic or post-menopausal
Work A–E — assess and act as you go
The diagnoses you must not miss
tap to open eachWhat points toward it, what would rule it in, and how to manage it.
Sudden unilateral pain, vomiting, adnexal mass.
Clinical + USS; laparoscopy confirms.
Urgent laparoscopic detorsion.
Pain, PV bleeding, shock.
Pregnancy test, TVUSS.
See the ectopic page.
Sudden pain, often mid-cycle, haemoperitoneum.
USS, Hb.
Usually conservative; surgery if unstable.
Migratory pain, fever, discharge, PID history.
USS, CT, bloods.
Treat accordingly.
Investigate — what to order, when, and what it tells you
test with a question in mindPregnancy test
Pelvic USS
Bloods
How the plan comes together
disposition · handovertheatre
Suspected torsion → urgent gynaecology and laparoscopy.
Hand over: onset time, USS findings, pregnancy test.
home
Torsion excluded by senior review with a clear alternative diagnosis; safety-net for recurrent pain.
Sudden unilateral pain and vomiting: pregnancy test, ultrasound, gynaecology. Don't let a normal Doppler reassure you. Nicely done getting here.
Clerking template
copy or downloadOvarian torsion — documentation structure
A structure and prompt list to help you document and think systematically. It is not a completeness check and cannot guarantee nothing is missed — use your trust's own proforma, your seniors, and your clinical judgement.
Test yourself
active recallCover the answer, say it out loud, then reveal. Retrieval beats re-reading.
0 / 10 knownFrequently asked questions
quick answersWhat are the red flags for ovarian torsion?
- Sudden severe unilateral pelvic pain + vomiting — think ovarian torsion
- Known ovarian cyst / dermoid — think torsion risk
- IVF / ovarian stimulation — think torsion risk
- Positive pregnancy test — think ectopic first
- Fever, peritonism — think tubo-ovarian abscess / rupture
- Shock — think ruptured haemorrhagic cyst or ectopic
What is the initial management of ovarian torsion?
- Pregnancy test — exclude ectopic
- Analgesia + antiemetic — —
- IV access, bloods — FBC, CRP, G&S
- Pelvic USS (TV + Doppler) — enlarged ovary, mass, whirlpool sign, free fluid
- Nil by mouth — —
- Gynaecology urgently — for laparoscopy
Always alongside senior support and your local guideline.
What diagnoses must you not miss in ovarian torsion?
- Ovarian torsion — laparoscopy
- Ruptured ectopic — positive hCG
- Ruptured haemorrhagic cyst — free fluid · shock
- Appendicitis / TOA (mimics) — fever · RIF
Open each one in the must-not-miss section for what points toward it, how to rule it in, and how to manage it.
What investigations should a junior doctor order for ovarian torsion?
- Pregnancy test — First.
- Pelvic USS — Enlarged oedematous ovary, mass, whirlpool sign; normal Doppler doesn't exclude torsion.
- Bloods — FBC, CRP, G&S.
Admit or discharge: how is the plan decided for ovarian torsion?
- Theatre — Suspected torsion → urgent gynaecology and laparoscopy.
- Home — Torsion excluded by senior review with a clear alternative diagnosis; safety-net for recurrent pain.
Is there a clerking template for ovarian torsion?
Yes — there is a free clerking template for ovarian torsion on this page, structured as presenting complaint, red flags asked, history, examination (A–E), investigations, differentials, plan and escalation. You can copy it or download it as a Word document. Jump to the template.
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