Can ovarian torsion present with pain in the right lower flank and hip?

Ovarian Torsion and Right Lower Flank/Hip Pain

Yes, ovarian torsion can present with pain in the right lower flank and hip area, though this is not the most typical presentation pattern. 1

Clinical Presentation of Ovarian Torsion

• Ovarian torsion typically presents as severe, constant pain that may fluctuate in intensity but rarely completely resolves without intervention 1
• The classic presentation includes:
  • Sudden onset of unilateral lower abdominal pain 2
  • Nausea and vomiting (occurs in approximately 70% of cases) 3
  • Pelvic tenderness with a palpable laterouterine mass 4
• Pain may radiate to the flank or hip region due to:
  • Anatomical proximity of the ovaries to surrounding structures 1
  • Inflammation affecting nearby tissues 1
  • Referred pain patterns 5

Diagnostic Challenges

• Ovarian torsion is frequently misdiagnosed as it can mimic other conditions 5:
  • Appendicitis
  • Pyelonephritis
  • Nephrolithiasis (renal colic)
  • Urinary tract infection
• Case reports document patients initially presenting with flank pain who were ultimately diagnosed with ovarian torsion 4
• The diagnosis becomes particularly challenging because:
  • Symptoms may be present for several hours or days 5
  • Not every patient will have a palpable mass on examination 5
  • Pain patterns can be atypical and may radiate to the flank or hip 1

Imaging Findings

• Ultrasound is the first-line imaging modality for suspected ovarian torsion 1
  • Key findings: unilaterally enlarged ovary, peripheral follicles, abnormal or absent venous flow, and whirlpool sign 1
• CT findings may include:
  • Asymmetrically enlarged ovary with or without an underlying mass 6
  • Twisted pedicle (better visualized with multiplanar reformations) 6
  • Abnormal or absent ovarian enhancement 6
  • Deviation of the uterus to the side of the twist 6
  • Engorged vessels on the twisted side 6
• MRI has 80-85% sensitivity for ovarian torsion with findings of enlarged ovary, stromal edema, and absent/diminished enhancement 6, 1

Important Diagnostic Pitfalls

• Normal arterial blood flow on ultrasound does not rule out ovarian torsion 1, 5
  • Torsion can be intermittent or partial 5
  • Venous flow abnormalities are more sensitive 1
• Ovarian torsion can occur in females of all ages, including infants and the elderly 5
• Delayed diagnosis is common due to nonspecific symptoms and can lead to ovarian necrosis 4
• The presence of risk factors should increase suspicion:
  • Ovarian masses or cysts (most common risk factor) 2, 3
  • Recent ovarian hyperstimulation (as with IVF treatment) 7

Management Considerations

• Early surgical intervention is crucial to preserve ovarian function 4, 2
• If there is any clinical concern for ovarian torsion, prompt gynecologic consultation is recommended, even if imaging findings are not conclusive 5
• Surgery remains the standard method for definitive diagnosis and treatment 5