Study Objective: To evaluate how COVID-19 has affected the management of women who presented with suspected adnexal torsion. Design: A retrospective case-controlled cohort study. Setting: A tertiary hospital. Population: 25 women in the control group (surgical date 24th March 2019 to 23rd March 2020) and 36 women in the pandemic group (24th March 2020 to 23rd March 2021) with confirmed adnexal torsion. Methods: Electronic patient record reviewed looking at women that had confirmed adnexal torsion in surgery. Main outcome measures: Time taken between clinical diagnosis of suspected adnexal torsion and surgical confirmation. Results: The median number of hours between suspected diagnosis and operating time was 7 hours (range 0.5-45 hours) and 4 hours (range 1-53 hours) respectively, with no statistical difference between the two groups (p>0.05, p=0.27). Out of hours operating was 6.5 times (OR 6.5 95%CI 1.36-31.09, p=0.01) more likely in the pandemic group when compared to the control group. Surgical outcome demonstrated 60% (n=15) of patients required oophorectomy in the control group, compared with 38% (n=14) in the pandemic group. Conclusions: Whilst there was an increase in the likelihood of out of hours operating during the pandemic; we have demonstrated that our ability to undertake diagnostic test and to perform emergency surgery safely was not delayed overall due to the impacts of COVID-19. Funding: None Keywords: adnexal torsion; ovarian torsion; COVID-19