Ovarian torsion is a process that occurs when the ovary twists over the ligaments that support it in the adnexa. The fallopian tube often twists with the ovary and is then referred to as adnexal torsion. The ovary is supported by multiple structures in the pelvis. One ligament it is suspended by is the infundibulopelvic ligament, also called the suspensory ligament of the ovary, which connects the ovary to the pelvic sidewall. This ligament also contains the main ovarian vessels. The ovary is also connected to the uterus by the utero-ovarian ligament.  The ovary has dual blood supply from the ovarian arteries and uterine arteries. Twisting of these ligaments can lead to venous congestion, edema, compression of arteries, and, eventually, loss of blood supply to the ovary. This can cause a constellation of symptoms, including severe pain when blood supply is compromised. This is a true surgical emergency that can lead to necrosis, loss of ovary, and infertility if not identified promptly.