Nausea/vomiting (70%)
Sudden and sharp pain in the lower abdomen (50%)
Can be intermittent and insiduous, especially in those with history of cysts, PCOS
Commonly occurs simultaneously with vomiting
May occur for days to months intermittently before diagnosis is made
Up to 30% have no tenderness on bimanual exam
Most adults with<unk>  have abnormal or enlarged ovaries that serves as lead point for<unk> , but<unk>  is more likely to occur in normal sized ovaries in pediatrics
More than 50% of cases have no palpable adnexal mass
Fever (<2%)
Up to 20% of cases seen in pregnant women, with most in the 1st trimester and/or received fertility treatments
Can be intermittent and insiduous, especially in those with history of cysts, PCOS
Commonly occurs simultaneously with vomiting
May occur for days to months intermittently before diagnosis is made
More than 50% of cases have no palpable adnexal mass
Ovarian torsion
Appendicitis
Testicular torsion
Perforated appendicitis
Tubo-ovarian abscess
Peritonitis
Epididymitis
Abdominal aortic aneurysm