Recurrent ovarian torsion challenges in management and saving fertility: A rare case report

Ovarian torsion is a time-sensitive gynecologic emergency that may lead to irreversible ovarian damage. The condition becomes particularly critical in women with a solitary ovary, where timely diagnosis is essential to preserve fertility.

A woman of reproductive age with a history of right oophorectomy due to torsion of a mature cystic teratoma presented to the emergency department with acute lower abdominal pain, nausea, and vomiting. Pelvic ultrasound revealed the absence of the right ovary and a complex left ovarian cyst measuring 6 × 6 cm, with signs of congestion. Exploratory laparotomy revealed a twisted, violaceous left ovary measuring approximately 10 × 10 cm with two full twists of the infundibulopelvic (IP) and utero-ovarian (OU) ligaments. Detorsion was performed.

Current evidence challenges traditional practices of routine oophorectomy in torsion, as histologic studies report preserved viability in 43 % of ovaries despite ischemic appearance. This case reinforces the feasibility of detorsion in reproductive-aged women, particularly those with a solitary ovary, to safeguard fertility. The absence of contralateral ovarian tissue further underscores the need for conservative surgical approaches.

This report emphasizes the critical role of early recognition and conservative surgical management in ovarian torsion, especially in patients with a solitary ovary. Timely detorsion can prevent irreversible fertility loss, even in grossly ischemic-appearing ovaries. Patient education about acute pelvic pain and clinician vigilance in high-risk populations are essential to mitigate diagnostic delays.