A rare occurrence of ovarian accessory tissue torsion

The presence of an accessory ovary is a rare gynecological abnormality with unclear pathophysiology. Ectopic ovarian tissue is typically discovered incidentally during laparoscopy performed for other indications; however, these ovaries can present preoperatively similar to ovarian torsion, cyst rupture, or malignancy, prompting treatment. We present the case of a 42-year-old G2P2 with a four day history of pelvic pain. Pelvic ultrasound and computed tomography (CT) revealed a presumed 4 cm ruptured ovarian cyst. Given her persistent pain and imaging findings, we proceeded with a diagnostic laparoscopy. Intraoperatively, a large amount of edematous and hemorrhagic tissue was noted involving the right fallopian tube, and a right salpingectomy was performed. Further exploration revealed a pedunculated mass originating from a twisted stalk extending from the midline posterior uterine wall into the posterior cul-de-sac. This mass was removed and sent to pathology. There were no intraoperative complications, and the patient recovered well postoperatively. Pathology report concluded that the pelvic mass represented ovarian tissue with hemorrhage. Ectopic ovaries, however rare, can present with acute pathology and should be considered in the differential diagnosis in cases of pelvic masses or pain.