When should I refer a patient with suspected ovarian torsion to secondary care for surgical intervention?

Refer a patient with suspected ovarian torsion to secondary care urgently for surgical intervention if they present with acute onset pelvic or abdominal pain suggestive of torsion, especially if accompanied by adnexal mass or signs of ovarian compromise. Ovarian torsion is a surgical emergency requiring prompt assessment and intervention to preserve ovarian function and prevent complications.

Immediate referral to secondary care is indicated when clinical suspicion of ovarian torsion is high, as diagnosis is primarily clinical supported by ultrasound imaging. Delay in referral can lead to ovarian necrosis.

In primary care, if a woman presents with acute pelvic pain and an adnexal mass or ultrasound findings suggestive of torsion, urgent referral to gynaecology or emergency services for surgical evaluation is warranted.

While the provided NICE guidelines focus on ovarian cancer recognition and referral pathways, they emphasize urgent referral for pelvic masses and symptoms suggestive of serious pathology, which by analogy applies to ovarian torsion requiring surgical intervention ¹,².