Ovarian Torsion at 18 Weeks of Gestation Detorted Laparoscopically: A Case Report
Fatma Noorwali and Atheer Abdulqader Alboloshi*
ABSTRACT
Background: Ovarian torsion (OT) is a gynecological emergency that, if not managed promptly, can lead to irreversible ovarian damage. While adnexal torsion during pregnancy is rare, it occurs most frequently in the first trimester. Diagnosing OT during pregnancy can be challenging due to non-specific symptoms and unclear ultrasound imaging, often leading to delays in intervention. This case report describes the presentation and management of OT in the second trimester of pregnancy.
Case Presentation: A 37-year-old middle eastern woman at 18 weeks of gestation (G11P2+8) presented with right iliac fossa pain and nausea. Initial ultrasound was inconclusive. A subsequent pelvic MRI revealed an engorged, edematous right ovary with a volume of 60 ml and a tortuous fallopian tube, findings highly suggestive of acute ovarian torsion. The patient underwent urgent laparoscopic surgery, which confirmed a right ovary twisted three times around the infundibulopelvic ligament and appearing congested and nearly black. Successful laparoscopic detorsion was performed, upon which the ovary promptly regained its normal color. The patient and fetus remained in good health postoperatively.
Conclusion: This case highlights the presentation and management of OT during pregnancy. MRI is a valuable diagnostic tool when ultrasound findings are inconclusive. Moreover, laparoscopic detorsion is a safe and effective management option for preserving ovarian function in pregnant patients, even in the second trimester, with favorable outcomes for both the mother and fetus. We present a case of a pregnant lady presenting with ovarian torsion at her 18th week of pregnancy.
