What are the typical clinical manifestations of ovarian torsion?

Clinical Manifestations of Ovarian Torsion

Ovarian torsion typically presents with severe, constant unilateral lower abdominal or pelvic pain that may fluctuate in intensity but rarely resolves completely without intervention. 1

Primary Symptoms

• Acute onset of severe pelvic pain is the hallmark symptom, characteristically presenting as sharp, sudden, unilateral lower abdominal pain with tenderness 1, 2
• The pain pattern is typically constant rather than intermittent, though intensity may fluctuate, distinguishing it from conditions like renal colic 1
• Nausea and vomiting occur in approximately 70% of cases, making these cardinal associated symptoms 3
• Anorexia frequently accompanies the pain and nausea 2

Physical Examination Findings

• A palpable laterouterine pelvic mass may be detected on examination, often representing an enlarged ovary or underlying cyst 2
• Unilateral lower abdominal tenderness is typically present on the affected side 2
• Fever is NOT typically associated with ovarian torsion—its presence suggests alternative diagnoses such as tuboovarian abscess 1

Diagnostic Mimicry and Pitfalls

• Ovarian torsion commonly mimics other acute abdominal conditions, including appendicitis, renal colic, and urinary tract infection, leading to diagnostic delays 4, 2
• The sudden onset of severe pain is more characteristic of torsion than the periumbilical pain migrating to right lower quadrant seen in appendicitis 1
• Dysuria (burning during urination) can occur due to anatomical proximity of the ovaries to the bladder, with inflammation from torsion affecting nearby structures—this can misleadingly suggest UTI 1
• Pyuria on urinalysis has low positive predictive value and can result from genitourinary inflammation caused by ovarian torsion itself, not infection 1

Population Considerations

• While most common in reproductive-aged women, ovarian torsion can affect females of all ages including premenarchal girls, pregnant women, and postmenopausal women 3, 5
• Women undergoing fertility treatment are at increased risk and may present with abdominal pain that overlaps with ovarian hyperstimulation syndrome, complicating diagnosis 6

Critical Clinical Context

• The presentation is not always sudden or severe—abdominal or pelvic pain is common but variable in onset and intensity, which can delay recognition 3
• Early recognition is essential as delayed diagnosis leads to adnexal necrosis and potential infertility 1
• Ovarian torsion occurs in 2-15% of patients undergoing surgical treatment of adnexal masses, with the presence of an ovarian mass or cyst being the primary risk factor 5, 3