Torsion of a Theca-Lutein Cyst in Molar Pregnancy: A Rare but Critical Diagnosis

We present the case of a 22-year-old woman who initially presented with vaginal bleeding following a two-month menstrual delay and ultrasound suspicion of an anembryonic pregnancy. She underwent two manual uterine evacuations at a regional hospital, and histopathology confirmed a complete hydatidiform mole. She was referred to a gestational trophoblastic disease reference center with severe pelvic pain and persistent vomiting for two days, refractory to analgesics. On admission, she exhibited signs of peritoneal irritation. Ultrasound revealed the presence of theca-lutein cysts in the left ovary and torsion of the right ovary. Emergency exploratory laparotomy confirmed adnexal torsion and necrosis, requiring right salpingo-oophorectomy. Postoperative recovery was favorable, and serum β-human chorionic gonadotropin (β-hCG) levels normalized after nine months of follow-up. This case highlights the importance of considering ovarian torsion as a possible complication in patients with molar pregnancy presenting with acute abdominal symptoms. Timely imaging is crucial for diagnosis and may allow conservative management, although adnexectomy remains necessary in cases of established necrosis. Awareness of this rare but serious complication is essential for prompt diagnosis and preservation of reproductive potential.