What is the typical presentation of ovarian torsion and the initial management?

• A. Sudden, severe unilateral lower-quadrant pain with nausea/vomiting; urgent surgical evaluation for detorsion.
• B. Gradual dull ache relieved by NSAIDs.
• C. Intermittent pain during menses.
• D. Pain with fever and discharge.

Answer: (A)

Ovarian torsion typically presents with sudden, severe unilateral pelvic pain that comes on abruptly and is often accompanied by nausea and vomiting. This reflects an abrupt twist cutting off ovarian blood flow, risking ovarian necrosis if not treated quickly. Because salvaging ovarian function depends on prompt intervention, the initial management is rapid stabilization and urgent surgical evaluation with the aim of detorsion, usually via laparoscopy. Imaging with ultrasound and Doppler can support the diagnosis, but should not delay surgical management when torsion is strongly suspected. The other patterns—gradual dull ache relieved by NSAIDs, intermittent cyclical pain during menses, or pain with fever and discharge—fit other pelvic conditions rather than this acute vascular event.