Ovarian torsion occurs when an ovary twists about its vascular pedicle. The process causes abdominal pain and will result in ovarian tissue loss if not diagnosed and managed expeditiously. Acute ovarian torsion is an uncommon cause of abdominal pain in adolescents, and, as a result, it is often mistaken for other processes. We present a case of ovarian torsion in an adolescent female who presented with abdominal pain and marked abdominal distension, which was initially suggestive of a gravid abdomen. She was ultimately found to have a very large cystic teratoma of the right ovary with concomitant ovarian torsion. There are no reported cases of ovarian cystic teratoma with acute torsion presenting with an abdominal mass suggestive of a gravid abdomen.