Acute Pelvic Pain in a Reproductive Age Female (Non-Pregnant) (2025)-M1-COB05-2025

Video Transcription

Video Summary

The session reviews imaging and diagnostic “pearls and pitfalls” for acute pelvic pain in non‑pregnant females, emphasizing adnexal torsion and other gynecologic and non‑gynecologic emergencies. For torsion, key clinical clues include severe sharp pain plus nausea/vomiting. Imaging diagnosis is driven by edema: asymmetric ovarian enlargement (often >5 cm), free fluid, peripheral follicles (“string of pearls”), follicular ring sign, and heterogeneous parenchyma with infarction. The twisted pedicle (“whirlpool/target sign”) is highly useful and can be seen on ultrasound cine, CT, or MRI; abnormal adnexal position (“strange situs”) and pain with typically painless neoplasms (especially dermoid) should raise suspicion. Doppler flow may be preserved in most torsion cases, so it predicts viability rather than excluding torsion. Tubes and para‑ovarian cysts can torsion as well. A negative CT showing normal symmetric ovaries and no adnexal lesion has very high negative predictive value for torsion.<br /><br />Other adnexal causes reviewed include hemorrhagic cyst rupture with hemoperitoneum, endometrioma hemorrhage, dermoid rupture, PID spectrum (endometritis to tubo‑ovarian abscess), postpartum ovarian vein thrombosis, and ovarian hyperstimulation syndrome.<br /><br />Non‑adnexal/other causes include prolapsed submucosal fibroids (sometimes post‑embolization), uterine obstruction (hematometra/pyometra), IUD perforation/migration with fistula, cystitis/ureteral stones, and appendicitis. A European perspective highlights ultrasound first-line, CT when non‑gynecologic causes or bleeding suspected, and increasing emergency MRI use with fast protocols.

Keywords

acute pelvic pain

non-pregnant female

adnexal torsion

twisted pedicle whirlpool sign

ovarian edema and enlargement

Doppler flow viability

pelvic inflammatory disease tubo-ovarian abscess

hemorrhagic ovarian cyst rupture hemoperitoneum

emergency pelvic imaging ultrasound CT MRI