🔑 Key Learning

  • Gynaecological emergency characterised by sudden onset unilateral pelvic pain.
  • Caused by twisting of the ovarian vascular pedicle, leading to ischaemia.
  • 1st line investigation:TVUS
    • May show the "whirlpool sign" (twisted pedicle).
  • Management is emergency laparoscopy to detorse the ovary and prevent necrosis.

🧬 Pathophysiology

  • Torsion of the ovary and often the fallopian tube around the vascular pedicle.
    • Venous outflow is obstructed first → ovarian oedema → arterial compromise.
      • If untreated, leads to ischaemia, infarction, and potential loss of ovarian function.

👀 Clinical Features

  • Sudden onset severe lower abdominal pain, typically unilateral (LIF or RIF).
  • Pain may be intermittent if torsion is partial or resolves temporarily.
  • Nausea and vomiting are common.
  • On examination:
    • Localised abdominal tenderness, often with guarding.
    • Possible palpable adnexal mass.

🧪 Investigations

  • First-line imaging: Transvaginal ultrasound (TVUS).
  • Whirlpool sign: twisted vascular pedicle on Doppler imaging, suggestive of torsion.
  • May also see enlarged, oedematous ovary.

💊 Management

  • Emergency surgical detorsion is required to restore ovarian blood flow.
    • Laparoscopy is preferred.
      • If the ovary is necrotic or associated with a large mass or tumour, oophorectomy may be necessary.

📝 Exam Clues & Clinchers

  • Young woman with sudden-onset RIF or LIF pain, nausea, and vomiting - consider ovarian torsion
  • Doppler ultrasound showing whirlpool sign.
  • Emergency laparoscopy is the definitive treatment.