- most common in third decade of life - 90% of adenexal torsion associated with cystic tumours or simple cysts of ovary - torsion of fallopian tube less common, a/w hydrosalpinx, tubal ligation, and pelvic adhesions - pain associated with adnexal torsion / ovarian torsion i ssudden onset, sharp, unilateral, and increasingly severe on background of a dull pelvic ache - radiates from pelvis to the flank ('reverse renal colic') and associated with **nausea, vomiting, low-grade pyrexia** and urinary symptoms 2/2 bladder irritation - late cases can present with ovarian necrosis, frank peritonitis, and shock