Postmenopausal ovarian torsion with intratumoral gas and markedly elevated CA-125/CA 19-9: A case report

Adnexal masses in postmenopausal women represent a significant clinical challenge. This case report describes the clinical presentation, diagnostic evaluation, and surgical management of a large adnexal mass complicated by ovarian torsion in a postmenopausal woman. A 65-year-old postmenopausal woman with long-standing abdominal distention presented with acute pelvic pain, early satiety, and constipation. Computed tomography revealed a 20.6 × 16.5 cm torsed adnexal mass with a twisted vascular pedicle, intratumoral hemorrhage, intratumoral gas and peritumoral fluid. Mass shows no enhancement in post contrast images. Serum CA 125 and CA 19-9 were markedly elevated. Exploratory laparotomy revealed a twisted left ovarian mass with ischemic changes. Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO) were performed. Following surgery, she had uneventful recovery and reported symptom resolution by day three. Gross pathology showed no features of malignancy. This case highlights that large adnexal masses in postmenopausal women require urgent evaluation. Although elevated tumor markers may mimic malignancy, torsion and benign pathology can present similarly. Final diagnosis was torsion of a benign ovarian mass with ischemic infarction. Early surgical intervention is essential to avoid such complications.