A 30 yrs old female, presents to the emergency with complaint of sudden severe abdominal pain; an abdominal mass is palpable on examination; Most likely diagnosis is:
**Core Concept**
The sudden onset of severe abdominal pain in a young female, accompanied by a palpable abdominal mass, suggests a diagnosis related to ovarian pathology. **Ovarian torsion** and **ruptured ovarian cyst** are two possible diagnoses, but the presence of a palpable mass makes **ovarian torsion** more likely.
**Why the Correct Answer is Right**
Ovarian torsion occurs when the ovary twists on its pedicle, cutting off its blood supply. This can lead to severe abdominal pain, nausea, and vomiting. The presence of a palpable mass suggests that the ovary has become twisted, causing the mass to become ischemic. **The ovarian ligament and infundibulopelvic ligament** are key structures involved in the torsion.
**Why Each Wrong Option is Incorrect**
* **Option A:** **Ruptured ectopic pregnancy** is a possibility in a young female with abdominal pain, but it is less likely in this case since a palpable mass is not typically associated with ectopic pregnancy.
* **Option B:** **Appendicitis** can present with abdominal pain and a palpable mass, but the pain is usually more gradual in onset and the mass is typically located in the right lower quadrant.
* **Option C:** **Diverticulitis** can present with abdominal pain and a palpable mass, but the pain is usually more chronic and the mass is typically located in the left lower quadrant.
**Clinical Pearl / High-Yield Fact**
When evaluating a young female with sudden onset abdominal pain and a palpable mass, remember the **"SO"** rule: **S**udden onset, **O**varian pathology, and **O**varian torsion.
**Correct Answer:** C.