Atypical Presentation of a Giant Hemorrhagic Ovarian Cyst

Hemorrhagic ovarian cysts (HOCs) are frequently seen in reproductive age women, developing in the luteal phase of ovulatory cycles. Giant HOCs are rare, as bleeding inside a closed space causes acute pain leading to early diagnosis. Anovulation or oligoovulation is a defining feature of polycystic ovarian syndrome (PCOS), and hence, functional cysts are uncommon in PCOS patients. This report describes a young girl with PCOS and amenorrhea, presenting with a giant hemorrhagic ovarian cyst. Most hemorrhagic cysts undergo spontaneous resolution with follow-up. Our patient presented as a surgical emergency following torsion and rupture with hemoperitoneum. Torsion causes an obstruction in the blood flow leading to infarction and loss of ovarian viability. Early diagnosis and detorsion may help to preserve ovarian function.