Aim and objective: Adnexal torsion is a rare gynecological emergency. It involves females of all age-groups. It requires early diagnosis and intervention in order to save the adnexa from irreversible injury. Our study elaborates on the clinical presentation, diagnosis, and management of adnexal torsion in a tertiary care center in India. Study design: Prospective study. Materials and methods: It is a clinical study conducted at Sri Ramachandra Institute of Research and Higher Education over a period of 1 year from January 2018 to January 2019. Results: Most cases of adnexal torsion presented with diffuse pain abdomen (64.2%), nausea and vomiting (42.8%). About 60% were mainly found in the reproductive age-group of 20–30 years. Five antenatal cases with adnexal torsion were observed (11%). Polycystic ovaries (21.4%) and hypothyroidism (50%) were the notable risk factors associated with this complaint. Size more than 5 cm were increasingly associated with adnexal torsion. Ultrasound was used as a primary imaging modality although in few cases like pregnancy, large masses in which ultrasound was inconclusive CT and MRI were more convincing. Laparoscopy was the preferred mode of intervention with an attempt to conserve the ovary in childbearing age-group. However, 24% of cases were converted to laparotomy in view of large size of the mass or hemodynamic instability. Conclusion: Adnexal torsion is one of the rare emergency which requires an expertise team for early diagnosis using imaging and clinical symptoms. Prompt surgical intervention is required to preserve the ovarian tissue especially in younger age-group.