Ovarian Torsion without Mass in Early Gestation: Successful Conservative Approach

Abstract

Ovarian torsion occurring during pregnancy is a rare but serious complication that can cause significant morbidity for both the mother and the fetus. Its pathophysiology remains incompletely understood, although several predisposing factors have been identified, including increased ovarian volume, increased mobility of the ovary, and an elongated vascular pedicle. The risk is particularly elevated in the context of ovarian stimulation for infertility treatments. Diagnosis relies primarily on imaging, with pelvic ultrasound as the first-line examination, sometimes supplemented by Magnetic Resonance Imaging (MRI) when ultrasound findings are inconclusive. We report the case of a patient at 10 weeks of amenorrhea with a progressing singleton pregnancy, who presented to the emergency department with acute pelvic pain. Clinical evaluation combined with imaging studies led to the diagnosis of right ovarian torsion. An urgent laparoscopic surgery was performed, allowing detorsion of the twisted adnexa. The ovary was found to be viable intraoperatively and was preserved, thus avoiding oophorectomy and maintaining both reproductive function and the normal progression of the pregnancy.