Ovarian torsion - probable
Right iliac fossa pain, guarding and rebound tenderness. Pain for 3 days, elevated white cell count. Differential ovarian cyst versus appendicitis.
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The right ovary is enlarged, measuring 8.1 x 5.1 x 7.3 cm. Peripheral follicles are seen, no internal vascularity. There is right adnexal tenderness, and a small amount of free fluid.
The left ovary has a normal appearance, measuring 2.5 x 2.0 x 4.3 cm and is normal vascularity.
The uterus is anteverted, measuring 4 x 3 x 5 cm. It is mobile and non-tender.
Enlarged avascular right ovary is suspicious for ovarian torsion.
The patient was transferred to a specialist women's hospital for further treatment.