Where is ovarian torsion pain typically located?

Location of Ovarian Torsion Pain

Ovarian torsion pain typically presents as severe, constant pain in the lower abdomen or pelvis, usually unilateral (on the side of the affected ovary), that may fluctuate in intensity but rarely completely resolves without intervention. 1

Clinical Presentation

• Ovarian torsion causes severe, sharp, sudden onset of unilateral lower abdominal pain and tenderness, often accompanied by nausea and vomiting (occurring in approximately 70% of cases) 1, 2
• The pain is typically located on one side of the lower abdomen/pelvis corresponding to the affected ovary 1
• Pain may fluctuate in intensity but rarely resolves completely without treatment 1, 3
• The condition can mimic other causes of acute pelvic pain such as:
  • Appendicitis (especially with right-sided torsion) 1, 4
  • Renal colic 5
  • Urinary tract infection 1, 2
  • Diverticulitis 4

Diagnostic Considerations

• Palpation often reveals a laterouterine pelvic mass with unilateral tenderness 5
• Ovarian torsion can affect females of all ages, including postmenopausal women, though it's more common in reproductive-aged women 2, 6
• In postmenopausal women, ovarian torsion is often associated with ovarian masses and carries a higher risk of malignancy 6
• The main risk factor for ovarian torsion is the presence of an ovarian mass or cyst 7

Imaging Findings

• Ultrasound is the first-line imaging modality for suspected ovarian torsion 1

  • Key findings include unilaterally enlarged ovary (>4 cm or volume >20 cm³) 1
  • Peripheral follicles are found in up to 74% of cases 8, 1
  • Abnormal or absent venous flow has 100% sensitivity and 97% specificity 1
  • The "whirlpool sign" (representing twisted vascular pedicle) has 90% sensitivity in confirmed cases 1

• CT findings (when ultrasound is inconclusive or unavailable):

  • Asymmetrically enlarged ovary with or without an underlying mass 1, 4
  • Twisted pedicle 1
  • Abnormal or absent ovarian enhancement 1
  • Deviation of the uterus to the side of the twist 1

Important Clinical Pitfalls

• Normal arterial blood flow on ultrasound does not rule out ovarian torsion, as torsion can be intermittent or partial 1
• Venous flow abnormalities are more sensitive than arterial flow abnormalities 1
• Diagnostic delays are common due to nonspecific clinical features and uncommon objective findings 5
• Up to 5% of torsed ovaries have been reported to be of normal size, which can complicate diagnosis 8
• When ultrasound findings are inconclusive but clinical suspicion remains high, MRI (80-85% sensitivity) or CT may be utilized 1, 3

Management Implications

• Early and timely recognition with prompt intervention is crucial to preserve ovarian function and minimize morbidity 5
• The standard approach includes immediate surgical intervention with laparoscopic detorsion to preserve ovarian function 3
• Oophorectomy should be considered only in cases of definitive necrosis with no signs of recovery after detorsion, large malignant masses, or in postmenopausal women 3, 6