Time to untwist an adnexal torsion

Cheryl, a 42-year-old woman, presents to her GP on 27 December following a five-day history of worsening lower abdominal pain, with the previous day spent mostly in bed.

She has an uncomplicated medical history, no operations and a normal BMI. She had a normal delivery two years ago and wishes to conserve her fertility.

Cheryl had a pelvic ultrasound six months earlier for acute pain showing a spontaneously decompressed ovarian cyst.

Although the ovary was still bulky at the time of the scan, the report suggested it had resolved, so no follow-up was arranged.

Another ultrasound is requested in December (figure 1).

Figure 1: Ultrasound image showing a large complex adnexal mass with minimal Doppler flow.