Untwisting the Dilemma: Surgical Management of Ovarian Torsion in Pregnancy

Background: Ovarian torsion is a rare but significant gynecological emergency during pregnancy, with an estimated incidence of 1-5 per 10,000 pregnancies.It is most frequently encountered in the first trimester, often associated with ovarian cysts or hyperstimulated ovaries.Timely surgical intervention is crucial to preserve ovarian function and optimize pregnancy outcomes, but it also presents a clinical dilemma in balancing maternal safety vs fetal well-being.Case description: We report the case of a 27-year-old primigravida at 6 weeks, who presented with the acute onset of lower abdominal pain and vomiting.Clinical examination and ultrasonography revealed enlarged adnexa with absent vascular flow suggestive of ovarian torsion.Emergency laparoscopy was performed, revealing right-sided ovarian torsion with a 20 cm cystic lesion.Detorsion and cystectomy were undertaken with the preservation of ovarian tissue.The patient recovered uneventfully, and the pregnancy continued without further complications.Discussion: Surgical management of ovarian torsion in pregnancy is challenging, as delayed intervention may result in the loss of ovarian reserve, infection, or peritonitis, while unnecessary oophorectomy can compromise fertility.Minimally invasive laparoscopy has emerged as the preferred surgical approach, even in pregnancy, due to faster recovery, reduced adhesion formation, and safety for both the mother and the fetus.Literature supports conservative management with detorsion whenever feasible, reserving oophorectomy for non-viable ovaries.Conclusion: Early recognition and prompt laparoscopic intervention are vital in managing ovarian torsion during the first trimester of pregnancy.Conservative detorsion and cystectomy can preserve ovarian function while ensuring favorable maternal and fetal outcomes.