Ovarian Torsion in Normal Ovaries in Reproductive-Aged Women

Ovarian torsion is a gynecological emergency caused by the rotation of an ovary on its supporting ligaments, which can obstruct blood flow and lead to ovarian necrosis if untreated. Typically, torsion is associated with ovaries enlarged by cysts or masses, which increase the likelihood of rotation around the supporting ligaments. Although torsion can also occur in normal ovaries, especially in premenarchal girls with elongated infundibulopelvic ligaments, literature on this occurrence in reproductive-aged women is limited. This report presents two cases of ovarian torsion in normal ovaries, highlighting diagnostic and management challenges. The first case involves a 19-year-old who presented with acute right iliac fossa pain. Ultrasound showed a normal ovary with intact blood flow. However, due to ongoing pain, she underwent laparoscopy, which confirmed a 1.5-twist torsion at the utero-ovarian ligament. Right ovarian detorsion was performed successfully, and her postoperative recovery was uneventful, with follow-up ultrasound showing no abnormalities. The second case describes a 40-year-old woman with a prior hysterectomy, presenting with left iliac fossa pain. Ultrasound showed an enlarged, heterogeneous left ovary (5 × 3.2 × 4.2 cm) with poor blood flow and complex free pelvic fluid, raising suspicion for torsion. Emergency laparoscopy confirmed a 2-twist torsion on the infundibulopelvic ligament. Despite attempts at detorsion, the ovary remained nonviable, leading to left oophorectomy. These cases emphasize that ultrasound and Doppler findings may not reliably detect torsion in normal ovaries. Laparoscopy remains the definitive method for diagnosis and intervention, providing timely treatment that is essential to preserve ovarian function. Clinicians should maintain a high suspicion for torsion in reproductive-aged women with acute abdominal pain, even if imaging is inconclusive, to prevent severe complications. These cases highlight the need for heightened awareness of ovarian torsion in normal ovaries to optimize surgical outcomes and fertility preservation.