Twisting in the abdomen and pelvis: a review of organ torsions

Torsion of abdominal and pelvic organs, such as the spleen, gallbladder, omentum, epiploic appendages, fallopian tube, and epididymis/testicular appendix are relatively rare, and yet clinically significant, often imitating more common causes of acute pain. Given the nonspecific presentation and limited value of laboratory tests, imaging drives early recognition and timely, organ-preserving management. This review consolidates pathophysiology, modality-specific appearances, and practical diagnostic strategies for uncommon non-intestinal torsions. The unifying mechanism is rotation around a mesenteric or vascular stalk that first impedes venous outflow, then compromises arterial supply, culminating in edema, ischemia, and possible infarction. Predisposing conditions include congenital ligamentous or mesenteric insufficiency and acquired factors such as trauma, pregnancy, mass effect, and age-related laxity. Ultrasound may demonstrate organ enlargement, asymmetric morphology of paired organs, and, when captured, the twisted pedicle (‘whirlpool’ sign). Doppler findings may support the diagnosis but preserved arterial signals do not exclude torsion. CT allows clearest delineation of organ displacement, pedicle twisting, hypoenhancement, and inflammatory fat stranding. CT is especially helpful in diagnosing splenic and gallbladder torsion and in distinguishing omental torsion from epiploic appendagitis. MRI, as a radiation-sparing alternative, reliably depicts early ischemic change and variations of pelvic anatomy. Management varies from conservative therapy for epiploic appendage torsion to urgent detorsion or definitive resection for splenic, biliary and gonadal torsions. Familiarity with cross-sectional hallmarks, modality-appropriate workflows can shorten time to intervention and enhance organ salvage and outcomes.