Adnexal torsion is an interesting, uncommon, and potentially lethal condition that may arise most unexpectedly in women of any age, but particularly during the reproductive years. It is generally unilateral and may involve either normal or pathologically enlarged ovary or tube, or both organs. The condition may be partial or complete, the latter often resulting in gangrene and marked exacerbation of symptoms. If untreated, it may progress to necrosis and gangrene, followed by peritonitis, which may be lethal. Prompt diagnosis, in which timely diagnostic laparoscopy and ultrasound evaluation of the pelvis may be helpful, provides the opportunity for prompt laparotomy with untwisting of the torsion and stabilization of the adnexa by suture and cystectomy, if possible, extirpation if not. Organ conservation requires a clear need to preserve reproductive or ovarian function, so cystectomy is generally preferable to oophorectomy.