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Adnexal Torsion

by S. Gene McNeeley, MD

Adnexal torsion is twisting of the ovary and sometimes the fallopian tube, cutting off the blood supply of these organs.

  • Twisting causes sudden, severe pain and often vomiting.

  • Doctors use an ultrasound device inserted into the vagina (transvaginal ultrasonography) to confirm the diagnosis.

  • Surgery is done immediately to untwist the ovary or to remove it.

An ovary and sometimes the fallopian tube twist on the ligament-like tissues that support them. Twisting of an ovary (adnexal torsion) is uncommon but is more likely to occur in women of reproductive age. It usually occurs when there is a problem with an ovary. The following conditions make it more likely to occur:

  • Pregnancy

  • Use of hormones to trigger ovulation (for infertility problems)

  • Enlargement of the ovary, usually due to noncancerous (benign) tumors or cysts

Noncancerous tumors are more likely to cause twisting than cancerous ones.

Rarely, a normal ovary twists. Children are more likely to have this type of torsion.

Adnexal torsion usually occurs on only one side. Usually, only the ovary is involved, but occasionally, the fallopian tube also twists. Sometimes the blood supply to the ovary is cut off long enough to cause tissue in the ovary to die. Adnexal torsion can cause peritonitis—infection of the spaces in the abdomen (abdominal cavity) and the tissues lining it.

Did You Know...

  • The ovary sometimes twists, causing sudden, severe pain.


When an ovary twists, women have sudden, severe pain in the pelvic area. The pain is sometimes accompanied by nausea and vomiting. Before the sudden pain, women may have intermittent, crampy pain for days or occasionally even for weeks. This pain may occur because the ovary repeatedly twists, then untwists. The abdomen may feel tender.


  • Ultrasonography

Doctors usually suspect the disorder based on symptoms and results of a physical examination.

Ultrasonography using an ultrasound device inserted into the vagina (transvaginal ultrasonography) is done to confirm the diagnosis. This procedure can also usually determine whether blood flow to the ovary has been cut off.


  • Surgery to untwist the ovary

If ultrasonography supports the diagnosis, women are treated immediately. One of the following procedures is used to try to untwist and thus save the ovary:

  • Laparoscopy: Doctors may make one or more small incisions in the abdomen. They then insert a viewing tube (laparoscope) through one incision. Using instruments threaded through other incisions, they try to untwist the ovary and, if also twisted, the fallopian tube. Laparoscopy is done in a hospital and usually requires a general anesthetic, but it does not require an overnight stay.

  • Laparotomy: Doctors make a larger incision in the abdomen. A laparoscope is not used because doctors can directly view the affected organs. Because the incision is larger, it requires an overnight stay in the hospital.

If an ovarian cyst is present and the ovary can be saved, the cyst is removed (called cystectomy).

If the blood supply was cut off and tissue died, removal of the fallopian tubes and ovaries (salpingo-oophorectomy) is necessary.

If an ovarian tumor is present, the entire ovary is removed (called oophorectomy).

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