Rare case of adnexal torsion in pregnancy: A comprehensive review of recent diagnostic and surgical management approaches

Abstract

Adnexal torsion (AT) during pregnancy is a rare but critical condition that poses significant challenges in diagnosis and management. We present the case of a 22-year-old primigravida at 14 weeks of gestation with no predisposing factors, who presented with acute right-sided pelvic pain. Imaging, including transabdominal ultrasound and MRI, indicated a viable pregnancy with an enlarged, multifollicular right ovary, suggesting AT. The patient underwent an emergency laparoscopy, confirming right-sided adnexal torsion. After successful detorsion, postoperative recovery was uneventful, and follow-up imaging confirmed ongoing pregnancy viability with preserved ovarian function. Given the nonspecific clinical presentation, the diagnosis of AT in pregnancy often requires high clinical suspicion supported by imaging modalities. While ultrasound remains the primary diagnostic tool, MRI can offer additional diagnostic clarity when ultrasound findings are inconclusive. The treatment of AT in pregnant women is primarily surgical, with recent guidelines favoring conservative approaches aimed at preserving ovarian function. Laparoscopy is the preferred method for pregnancies under 17 weeks, with emphasis on safety protocols. Conservative management, including detorsion, is recommended for viable ovaries, while oophorectomy is reserved for cases with necrotic tissue. Overall, the prognosis is favorable, with most cases resulting in functional ovarian recovery and continued pregnancy viability. • Adnexal torsion revealed in pregnancy without any classical risk factors. • Atypical ovary mimicked hyperstimulation in absence of ovulation induction. • Combined ultrasound and MRI crucial for timely, accurate diagnosis. • Conservative laparoscopic detorsion preserved fertility and fetal health. • Case challenges conventional understanding of torsion pathophysiology