Adnexal Torsion - Diagnosis Features and the Case Showing Perils of Delay in Diagnosis

Adnexal torsion, characterized by the twisting of an ovary or fallopian tube, poses a critical gynaecological emergency with high morbidity. A young woman presented with sudden sharp pelvic pain, nausea, vomiting, and abdominal distention, revealing significant hemoperitoneum and a low haemoglobin level. Initial ultrasound was inconclusive in most of the cases like in this case; however, MRI demonstrated an enlarged right ovary, twisted fallopian tube, and hemoperitoneum with a ‘whirlpool sign.’ Emergency laparoscopic surgery confirmed right tubo-ovarian torsion, leading to right salpingo-oophorectomy. This case highlights the MRI findings of the adnexal torsion with critical importance of early diagnosis and timely intervention to prevent irreversible tissue damage and preserve ovarian function. Adnexal torsion is a critical gynaecological emergency characterized by the twisting of an ovary or fallopian tube around its supporting ligaments, which can lead to compromised blood flow and potential tissue necrosis.[1] Adnexal torsion is often misdiagnosed due to clinical and radiological inconsistency. Adnexal torsion typically affects women of reproductive age and can occur in the absence of underlying pathology or in conjunction with ovarian cysts or masses. It is confused with numerous gynaecological and surgical emergencies. This condition often presents with sudden, severe abdominal or pelvic pain and may be accompanied by nausea, vomiting, and fever. Prompt diagnosis and surgical intervention are crucial to restore blood flow and preserve ovarian function avoid the high morbidity associated with this condition. Delaying surgery can result in complications such as infections, adhesions, peritonitis, sepsis and even death.[2] We are presenting a case of diagnosis of adnexal torsion with delayed presentation and highlighting the consequences of missing the early diagnosis of adnexal torsion in the emergency setting.