Ovarian torsion presenting as massive oedema: diagnostic challenges and fertility-preserving management

Massive ovarian oedema (MOE) is a rare benign condition that can mimic ovarian neoplasms and lead to unnecessary oophorectomy. It is typically caused by impaired venous and lymphatic drainage secondary to partial or intermittent ovarian torsion, with preserved arterial inflow resulting in stromal oedema and maintained follicular viability. We report a woman in her late 20s presenting with intermittent mild lower abdominal pain and infertility. Ultrasound imaging suggested a solid ovarian mass; however, MRI demonstrated features consistent with a torsion-detorsion sequence, including heterogeneous stroma and peripherally displaced follicles. Laparoscopy confirmed adnexal torsion with a markedly enlarged but viable ovary. Detorsion and controlled stromal decompression were performed, followed by ligament-based ovariopexy using the Hot-Dog-in-a-Bun technique to reduce the risk of recurrence while preserving vascular integrity. Follow-up demonstrated complete resolution of ovarian enlargement and restoration of normal morphology. This case highlights the importance of recognising MOE and supports conservative laparoscopic management to avoid unnecessary ovarian loss in reproductive-age women.