Ovarian/Adnexal Torsion

Ovarian or adnexal torsion is when an ovary and in some cases the fallopian tube become twisted, cutting off the blood supply to the ovary.

While it can occur at any age, most cases of ovarian torsion are found in women under the age of 30.

Patients can be seen by Texas Children's experts in Pediatric and Adolescent Gynecology.

Causes & Risk Factors

Possible causes include:

  • Ovarian masses – particularly those that are benign, or noncancerous
  • Developmental abnormalities of the ovary or fallopian tube, such as elongated fallopian tubes
  • Trauma to the ovaries or fallopian tubes
  • Pregnancy, which may cause an ovary to become enlarged

Symptoms & Types

Symptoms may include:

  • Sudden, severe lower abdominal pain on one side
  • Nausea
  • Vomiting
  • Diarrhea
  • Tenderness in the lower abdomen
  • Abdominal swelling
  • Fever
  • Lower back pain
  • Dizziness

Diagnosis & Tests

Diagnosis starts with a detailed medical history and thorough physical exam, including a pelvic exam.

Additional testing may include:

  • Pregnancy test
  • Blood test
  • Pelvic ultrasound
  • CT (computed tomography) scan or MRI (magnetic resonance imaging) of the abdomen and pelvis
  • Laparoscopy – A very thin tube with a camera on the end (a laparoscope) is inserted into the abdomen through a small incision to view the ovaries

Because of the sudden onset of extreme pain, ovarian torsions are often diagnosed in the emergency room. 

Treatment & Care

Treatment strategies include:

  • Prescription or over-the-counter pain medications
  • Medications to stop nausea and vomiting
  • Intravenous fluids
  • Surgery to untwist the ovary or to remove an ovary damaged by lack of blood supply; typically laparoscopic surgery is used for less severe cases