Abdominal Pain in the Post-menopausal Female: Is Ovarian Torsion in the Differential?

BACKGROUND: Ovarian torsion is often thought of as a disease process of reproductive-aged women; however, it is also seen in the extremes of age. In post-menopausal women, it can be both a challenge to diagnose and associated with increased morbidity. CASE REPORT: We present a case of a 68-year-old woman with sudden onset of lower abdominal pain 6 h before arrival at the emergency department (ED). She was diagnosed with ovarian torsion, secondary to an ovarian mass, and underwent a full malignancy evaluation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Given the higher risk of malignancy in post-menopausal women, ovarian mass-related torsion is an uncommon but important cause of acute-onset lower abdominal pain. Due to the lower prevalence of ovarian torsion in the post-menopausal group, delayed or missed diagnosis is common and may increase associated morbidity. This morbidity is due to the increased likelihood of malignancy and complications of associated medical and surgical treatment of the mass. This report highlights the increased malignancy risk, difficulty with diagnosing torsion in the post-menopausal age group, and the rationale for different management strategies when compared to premenopausal women.