A 19-year-old woman presents with sudden onset severe right lower abdominal pain and vomiting for 6 hours. She has a history of a known right ovarian cyst on previous ultrasound. Examination reveals tenderness and guarding in the right iliac fossa with a palpable tender adnexal mass. Doppler flow study shows preserved arterial flow to the ovary. What is the most appropriate next step in management?

• A Laparoscopic oophorectomy
• B CT abdomen to confirm loss of perfusion before surgery
• C Analgesia and outpatient review after 48 hours
• D Diagnostic laparoscopy with detorsion of the adnexa ✓

Explanation

Ovarian torsion is a surgical emergency; the standard of care is prompt laparoscopy with detorsion and conservation of the ovary regardless of its gross appearance, as viability often recovers. Preserved Doppler flow does not exclude torsion because the ovary has a dual blood supply and arterial flow may persist even in complete torsion, so waiting for absent flow or proceeding to imaging delays treatment and risks necrosis.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.