A typical presentation of multiple mature cystic teratomas mimicking intermittent ovarian torsion and malignancy: A case report

Introduction: Large complex ovarian masses with solid components and intermittent severe pain present a diagnostic dilemma between intermittent torsion and malignancy. This case is unique due to the completely episodic pain pattern without nausea or vomiting, combined with resource limitations precluding safe laparoscopic containment, leading to deliberate open surgery for an ultimately benign condition, adding to the literature on resource-adapted surgical decision-making in academic settings. Case presentation: A 35-year-old woman (G1P1) presented with recurrent episodes of severe sharp right lower quadrant pain that resolved completely between attacks. Ultrasound revealed a 9 cm complex right ovarian mass with echogenic solid areas and acoustic shadowing. Intervention and outcome: After oncology consultation and with tumor markers pending, open right ovarian cystectomy was performed via Pfannenstiel incision because an endobag was unavailable. Three intact mature cystic teratomas were enucleated without spillage, ovarian tissue was preserved, and no torsion was found. Histopathology confirmed benign disease. The patient had complete pain resolution and an uneventful recovery. Conclusion: Ovarian torsion may present with purely intermittent pain. Large complex adnexal masses require oncologic vigilance. When equipment for spillage-free laparoscopy is unavailable, open cystectomy remains a safe, effective, and oncologically sound approach.