A 43-year-old woman presented to the emergency department with acute right lower quadrant abdominal pain, nausea, and bloating for the past day. Her medical history included a Roux-en-Y gastric bypass procedure 14 years prior. On abdominal examination she had focal guarding in her right lower quadrant. A computed tomographic scan of her abdomen and pelvis showed a multicystic heterogeneous right ovarian mass. Exploratory laparotomy revealed a large right hemorrhagic ovarian cyst with ovarian torsion of the infundibular ligament and vascular pedicle (image A, arrow). She underwent an oophorectomy. 

Fifty-four weeks later, she presented to her primary care physician with similar abdominal pain in the left lower quadrant. A computed tomographic scan showed a left ovarian mass (image B, arrow). Exploratory laparotomy revealed 540° torsion of her left ovary, and histologic examination revealed a large left hemorrhagic cyst with torsion. The patient underwent an oophorectomy. 

Ovarian torsion can affect women of all ages but rarely occurs in women after menopause.¹ It frequently presents as an acute abdomen and thus should be considered in the differential diagnoses in female patients with acute abdominal pain.¹ The risk of ovarian torsion is greater for premenopausal women, pregnant women, and women who have hyperstimulated ovaries.¹