Gynecologic pathology may manifest as an acute abdomen. Pelvic inflammatory disease, usually from gonococcus or Chlamydia, may cause lower abdominal pain and toxicity. Ruptured tubo-ovarian abscess can cause diffuse peritonitis. Follicular cysts can cause mittleschmerz, and rupture can cause hemoperitoneum and peritoneal irritation (see massive hemorrhage from an ovarian cyst.) Ectopic pregnancy can cause lower abdominal pain, and rupture can cause life-threatening hemoperitoneum.
Adnexal structures may torse, particularly if there is ovarian enlargement from cystic or solid neoplasms (see ovarian mucinous cystadenoma.) Tubo-ovarian torsion is an acute surgical emergency. Often the veins beyond the point of torsion are engorged with clot. Such a torsion should not be untwisted before the pedicle is clamped because of the risk of pulmonary embolus.
Link to this frame from your Personal Thumbnails page?