Ovarian torsion: Factors impacting diagnosis

Ovarian torsion is a rare gynecological emergency that occurs when the ovary spontaneously becomes twisted on itself. If not recognized and treated, it can result in tissue necrosis and loss of the ovary. Ovarian torsion most frequently affects women and people with ovaries in their childbearing years, and if oophorectomy is required from missed diagnosis, this can result in decreased fertility of the individual. Due to the broad differential diagnoses present with abdominal pain, ovarian torsion diagnosis is challenging for clinicians. An integrative review of available data was completed to determine factors that impact the diagnosis of ovarian torsion in adult non-pregnant women who present to the emergency department. A literature search was conducted using databases MEDLINE and CINAHL for articles in English and studies published from 2000-2025. A total of 12 papers were reviewed and data extraction completed to ascertain common factors impacting the diagnosis of ovarian torsion. Methods of diagnosis for ovarian torsion include patient history and clinical exam, bloodwork and urinalysis, and imaging via ultrasound and/or computed tomography. There has been improvement in ovarian salvage rate in the last 20 years, possibly due to increased preference for attempting ovarian salvage versus oophorectomy even if ovaries appear dusky on initial exam. No single physical exam or diagnostic can rule out torsion definitively, and care should not be delayed obtaining an ultrasound if high suspicion for ovarian torsion. The gold standard for diagnosis and treatment of ovarian torsion remains operative exploration, and clinicians should not hesitate to involve obstetrics and gynecology promptly when they suspect a patient has ovarian torsion.