Ovarian Torsion

Sudden unilateral lower abdominal or pelvic pain with nausea or vomiting should place adnexal torsion high on the NP's differential. The pain may wax and wane as the adnexa partially twists and untwists, so intermittent improvement is not reassuring. Venous and lymphatic obstruction can progress while arterial flow remains detectable on Doppler; a reassuring flow pattern cannot safely close the case. The immediate clinical question is not whether a scan can prove torsion—it cannot—but whether the presentation warrants urgent gynecologic surgical evaluation while competing emergencies are assessed. In Canadian NP practice, initiate assessment and supportive care within provincial authority, local policy, and individual privileges, then activate the site's urgent gynecologic or surgical pathway. Keep the patient NPO, obtain IV access, treat pain and vomiting as ordered, and obtain β-hCG in anyone with reproductive potential. Do not require an ovarian mass before considering torsion in a child or adolescent, and do not let pregnancy delay appropriate surgical assessment.