Intended for healthcare professionals

Practice Practice Pointer

Recognition and initial management of ovarian torsion

BMJ 2023; 381 doi: (Published 28 April 2023) Cite this as: BMJ 2023;381:e074514
  1. Ayisha A Ashmore, ST5 obstetrics and gynaecology registrar1,
  2. Sarah Blackstock, ST7 paediatric registrar2,
  3. Conor Kenny, general practitioner3,
  4. Aemn Ismail, consultant gynaecological oncologist1
  1. 1Gynaecology Department, University Hospitals Leicester NHS Trust, Leicester, UK
  2. 2University College London Hospital, London, UK
  3. 3The Old Church GP Surgery, Chingford, London, UK
  1. Correspondence to: A Ismail aemn.ismail{at}

What you need to know

  • Ovarian torsion is a gynaecological emergency: a delay in diagnosis and referral can lead to a reduction in fertility

  • Ovarian masses are the most common cause of ovarian torsion, but torsion can occur in their absence, including in pregnancy and postpartum

  • Ovarian torsion can present without severe pain but instead with more vague symptoms such as isolated nausea and vomiting

  • The presence of ovarian blood flow on Doppler sonography cannot exclude ovarian torsion and so should not be used to dismiss the diagnosis of torsion in the presence of a suggestive history and clinical examination: seek a senior gynaecological opinion to determine the need for a diagnostic laparoscopy

A 35 year old woman presents to her local emergency department with intermittent episodes of severe left iliac fossa pain over a few weeks. The pain is increasing in intensity and associated with vomiting and fainting or dizziness. She is also 10 weeks pregnant.

What is ovarian torsion?

Ovarian torsion is a gynaecological emergency characterised by the ovary twisting or torting on the ligaments that suspend it within the pelvis. While the exact incidence is unknown, it accounts for 2-3% of all acute gynaecological emergencies.1

In torsion, the ovary typically twists around the infundibulo-pelvic ligament, also known as the suspensory ligament of the ovary, leading to compression of the ovarian vessels.2 If this compression continues, the ovary becomes oedematous and ischaemic. If left untreated over several hours, the ovary can become necrotic and haemorrhagic, leading to long term reduction in fertility.

There is limited evidence for the diagnosis and management of ovarian torsion, meaning uncertainties in the management of affected patients. In this article, we offer practical tips drawn from the available evidence and our clinical experience to help guide clinicians in their diagnosis and management of ovarian torsion.

Who gets it and how does it present?

Ovarian torsion usually presents in …

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