What are the key clinical features to consider when diagnosing ovarian torsion

Key clinical features for diagnosing ovarian torsion in a female patient include sudden onset of unilateral lower abdominal or pelvic pain, often severe and intermittent in nature. This pain may be accompanied by nausea and vomiting due to visceral irritation and autonomic response. Tenderness on pelvic examination localized to the affected adnexa is common, and there may be a palpable adnexal mass if the ovary is enlarged. Patients can also present with signs of peritoneal irritation if torsion leads to necrosis. The pain is typically acute but can be subacute or intermittent if torsion is partial or intermittent. Additionally, fever and leukocytosis may be present but are not consistent findings. Imaging, particularly ultrasound with Doppler, is crucial to support the diagnosis by demonstrating an enlarged ovary with peripheral follicles and absent or reduced blood flow, although normal Doppler flow does not exclude torsion. These clinical features combined with imaging findings guide the diagnosis and urgent management of ovarian torsion NICE NG126 Sintim-Damoa et al. 2017.