Illness script
Ovarian Torsion
Sudden severe unilateral pelvic pain with nausea/vomiting in a woman with an adnexal mass.
This illness script for Ovarian Torsion covers the classic presentation, who it affects, how you work it up, the mechanism, and first-line treatment—written for USMLE Step 1 and clerkship clinical reasoning.
Updated Jul 18, 2026All scripts
01
Who it affects
- Reproductive-age women, but any age
- Ovarian mass/cyst >5 cm (most common risk)
- Ovulation induction/pregnancy (enlarged ovaries)
- Dermoid cysts classically predispose
- Right side more common (sigmoid protects left)
02
Diagnostics & workup
- Sudden-onset severe unilateral lower abdominal/pelvic pain
- Nausea and vomiting common; intermittent pain possible
- Adnexal tenderness ± palpable mass on exam
- Transvaginal Doppler US: enlarged ovary, ↓/absent flow
- Whirlpool sign of twisted pedicle; normal Doppler doesn't exclude
- Definitive diagnosis: surgical (laparoscopic) visualization
03
Pathophysiology
- Ovary twists on infundibulopelvic/utero-ovarian ligaments
- Venous and lymphatic outflow occlude first → edema
- Progressive arterial compromise → ischemia/necrosis
- Enlarging mass acts as fulcrum promoting rotation
04
Treatment
- Emergent gynecologic surgical consult
- Laparoscopy with detorsion to preserve ovary
- Ovarian cystectomy of causative mass
- Oophorectomy if necrotic/nonviable tissue
- NPO, IV fluids, analgesia, antiemetics preop
- Time-sensitive to salvage ovarian function
Keep reading
Full library- Hypertensive Disorders of PregnancyNew or elevated blood pressure after 20 weeks gestation, ranging from gestational HTN to preeclampsia/eclampsia.
- Ovarian Tumors (Benign vs. Malignant)Adnexal mass; benign in young women, but malignant risk rises with age, size, and complexity.
Educational use only. This illness script is a study framework, not medical advice. Confirm decisions with current guidelines and your clinical supervisors.