Ovarian (Adnexal) Torsion Differential Diagnoses

Updated: Sep 29, 2022
  • Author: Erik D Schraga, MD; Chief Editor: Eugene C Lin, MD  more...
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Diagnostic Considerations

Confident and early diagnosis of ovarian torsion (adnexal torsion) is imperative. Color Doppler ultrasonography has a vital role in the examination of women with lower abdominal and pelvic pain. [21, 22]

Failure to consider ovarian torsion in the differential diagnosis is not uncommon, given the relative infrequency of this condition. Consideration is particularly imperative in a patient with known risk factors for the disease, such as ovarian mass, prior pelvic surgery, or pregnancy.

Adnexal torsion is not limited to women of reproductive age. [23] Ovarian tumors, both benign and malignant, are common in postmenopausal women and may result in torsion. As with other causes of abdominal pain, patients of advanced age are increasingly prone to unusual presentations of ovarian torsion.

More than 50% of patients with torsion in the pediatric age group have normal-sized ovaries. In those with indicative histories and absence of alternative diagnoses, further investigation must be sought.

In addition to the conditions listed in the differentials, problems to be considered include the following:

  • Ovarian tumor

  • Tubal ovarian abscess

  • Ureteral calculi

  • Perforated colonic carcinoma

Differential Diagnoses