Laparoscopically-treated Ovarian Torsion in a 32-Week Pregnancy: A Case Report

Ovarian torsion is a gynecologic emergency which, while rare during pregnancy, is associated with increased risk during pregnancy. Most torsions during pregnancy occur during the first and second trimester, with only 10.5% of cases reported during the third trimester.A 35-year-old woman at 32 weeks and 2 days of gestation presented with right lower quadrant abdominal pain. Transvaginal ultrasound demonstrated a large right ovarian cyst and decreased flow on color Doppler consistent with ovarian torsion. The diagnosis was confirmed via diagnostic laparoscopy with direct visualization of the necrotic, edematous ovarian cyst and pedicle, which had been torsed twice. The pedicle was detorsed and the necrotic cyst was resected while sparing as much of the normal ovary as possible. The patient provided written consent for publication of this case report. Data supports that laparoscopy is a safe and reasonable treatment for ovarian torsion during pregnancy. It is associated with shorter hospital stays and fewer postoperative complications without increasing the risk of obstetric or neonatal complications. Much of this data, however, is obtained from case reports of torsions during the first and second trimester. The incidence of third trimester ovarian torsion is estimated to be 5-10% of torsion cases that occur in pregnancy. This case demonstrates a successful laparoscopic treatment of a third-trimester torsion in a woman who went on to deliver a healthy baby girl by spontaneous vaginal delivery.