Successful pregnancy-preserving laparoscopic adnexectomy for complicated ovarian torsion during late pregnancy: A case report and review of the literature

INTRODUCTION AND IMPORTANCE: A rare disorder called ovarian torsion (OT) during pregnancy can harm both the mother and the fetus. Predisposing variables for the condition include enlarged ovaries, free mobility, and a long pedicle, despite the fact that its genesis is not entirely understood. When ovarian stimulation is used to treat infertility, the disease's incidence rises. Magnetic resonance imaging and ultrasound are examples of diagnostic imaging modalities (MRI). CASE PRESENTATION: A 26-year-old woman with a 33-week pregnancy presented to our emergency department with acute, severe left groin pain. Laboratory evaluation was unremarkable except for leukocytosis (18.800/μL) with neutrophil shift. A radiologist used ultrasound to examine the abdomen and pelvis, and the results revealed a bulk enlargement of the left adnexa. The patient underwent a non-enhanced MRI in order to obtain a conclusive diagnosis, which revealed a massive enlargement and torsion of the left ovary with large areas of necrosis. The patient underwent a successful laparoscopic adnexectomy with preservation of the pregnancy. She delivered a healthy baby and had an uneventful follow up period. DISCUSSION: The etiology of OT is largely unknown. Any tendency to rotate the infundibulopelvic and utero-ovarian ligaments should be considered as a possible etiology. The prevalence of OT among pregnant women is underreported and determined by small limited studies. CONCLUSION: Ovarian torsion should be included in the differential diagnosis of patients with suspected acute abdomen in advanced stages of pregnancy. In addition, MRI should be used as an alternative diagnostic modality in patients with normal sonographic findings.