A systematic review of physiopathology, clinical picture, and imaging of adnexal torsion is certainly useful to identify as soon as possible this emergency condition. An early identification and an adequate treatment are indispensable in order to achieve a proper outcome for the patient. The choice of the appropriate surgical approach can be challenging and should be made on the basis of an accurate evaluation of the ovarian lesion. Therefore, it would be useful to perform an intraoperative frozen section analysis in selected cases.