A Rare Case of Ovarian Dermoid Torsion in the Third Trimester: Clinical Challenges and Surgical Management

Adnexal torsion is an uncommon but serious complication of pregnancy, particularly rare in the third trimester, where it poses challenges for both diagnosis and management. We report the case of a 25-year-old primigravida at 36+3 weeks of gestation with a known right ovarian dermoid cyst who presented with acute abdominal and back pain. She had experienced multiple previous admissions for abdominal pain that were managed conservatively. Initial investigations, including ultrasound and MRI, confirmed the presence of an 8 cm complex right ovarian mass but did not conclusively demonstrate torsion. Despite conservative management and antibiotic therapy for suspected sepsis, her pain worsened, and laboratory results showed raised inflammatory markers. Owing to persistent symptoms and clinical deterioration, an emergency caesarean section with concurrent surgical management was undertaken. Intra-operatively, the right ovary was found to be twisted four times, and a cystectomy with partial oophorectomy was performed along with delivery of a healthy female infant. Postoperative recovery was favourable, and histopathology confirmed a dermoid cyst. This case highlights the diagnostic uncertainty of adnexal torsion in pregnancy, where overlapping symptoms can obscure recognition. It underscores the importance of maintaining a high index of suspicion, early multidisciplinary involvement, and timely surgical intervention to optimize maternal and neonatal outcomes.