Ovarian torsion

• Ovarian torsion usually presents in the first three decades of life and is predisposed in patients with co-existing ovarian pathology such as follicular cyst. 
• There may be history of similar episodes indicating intermittent torsion and spontaneous detorsion.
• Torsion causes venous outflow obstruction and engorgement of the ovary. Eventually arterial supply is compromised and necrosis ensues.
• Diagnosis is suggested by unilateral enlargement of a round or oval-shaped ovary containing multiple enlarged peripheral cysts (caused by transudation of fluid into follicles). Free fluid is present in the majority of cases. Peripheral blood flow may be present but may be absent with infarction.
• Ovarian hyperstimulation can present with abdominal pain and may show an enlarged multicystic ovary associated with ascites. However, the condition usually arises from ovarian hormone stimulation in the setting of infertility.
• Polycystic ovary syndrome typically presents with menstrual disturbance, obesity and hyperandrogenism.