While pain was originally intense, there had been gradual improvement in symptoms. Gynecologic exam reveals mild bilateral tenderness, and the question of a left sided pelvic mass was raised. At surgery, the ovary was enlarged, edematous, and black. There was a 720 degree torsion of the ovary. A unilateral salpingo-oophorectomy was performed.
Ovarian torsion is an important yet notoriously difficult diagnosis.
It can mimic a number of gynecologic and non-gynecologic conditions, appendicitis being one of the most important. A number of radiographic appearances have been described. In one series of pubertal and prepubertal females, unilateral ovarian enlargement was seen in all patients. In a study looking at an adult population, all patients with ovarian torsion had a unilaterally enlarged ovary. Unlike this patient, ovarian flow is often maintained in ovarian torsion.