PAINFUL ADNEXAL MASS

A   31-year-old woman   is  taken   to  the emergency   department  complaining of

severe  sudden  lower   abdominal   pain    for approximately   three   hours.  She

was at  work    when    she suddenly    developed   lower   abdominal   discomfort  and

pain,   which   got progressively   worse.  On  examination the abdomen is

tender, although    no  rebound tenderness  is  present,    and there   is  a   suggestion

of  an  adnexal mass    in  the cul-de-sac  area.   Ultrasound  shows   an  8   cm  left

adnexal mass    with    a   suggestion  of  torsion of  the ovary.

Sudden onset of severe lower abdominal pain in the presence of an adnexal mass
is presumptive evidence of ovarian torsion.