Ovarian torsion is the fifth most common gynaecological emergency with a reported prevalence of 2.7% in all cases of acute abdominal pain.  It is defined as the partial or complete rotation of the adnexa around its ovarian vascular axis that may cause an interruption in the ovarian blood flow.  Ischaemia is therefore, a possible consequence and this may lead to subsequent necrosis of the ovary and necessitate resection. As symptoms of ovarian torsion are non-specific and variable, this condition remains a diagnostic challenge with potential implications for future fertility.  Consequently, clinical suspicion and timely intervention are crucial for ovarian salvage. This case report illustrates the multiple diagnoses that may be incorrectly ascribed to the variable presentations of ovarian torsion. Furthermore, a conservative treatment approach is described in a 22-year old nulliparous woman, with the aim of preserving her fertility.