Ovarian torsion is an uncommon condition with potentially serious complications. Torsion occurs when the ovary twists on its ligamentous pedicle. Venous and then arterial blood flow are compromised, and the ovary becomes nonviable if the condition is not diagnosed and surgically corrected within a short time. Ovarian torsion can occur in utero, during infancy, and throughout childhood. The incidence is highest in postmenarchal girls. The presence of an ovarian cyst or tumor increases the risk of torsion, although approximately 50% of cases occur in girls with normal ovaries. An ovarian cyst on a prenatal sonogram places the newborn infant at increased risk for torsion and should alert the clinician to pursue the diagnosis if abdominal signs and symptoms arise.

The most common presenting symptom is abdominal pain that is usually severe in nature. Older girls may localize the pain to one of the lower quadrants. Nausea and vomiting are also frequently present. Fever is unusual unless the presentation is late. The clinical history often raises concerns about the possibility of appendicitis or a renal stone. The absence of hematuria makes the diagnosis of a stone less likely. The abrupt onset of severe pain should point the clinician away from the diagnosis of appendicitis, which usually has a more insidious onset.