A 31-Year-Old Primigravida Woman Presenting at 18 Weeks of Gestation With Right Ovarian Torsion Successfully Managed With Laparoscopic Adnexectomy

BACKGROUND Ovarian torsion is a gynecological emergency characterized by rotation of an ovary around the infundibulopelvic and utero-ovarian ligaments, which leads to impaired venous and lymphatic drainage and, if prolonged, arterial obstruction with potential ischemic necrosis. The clinical presentation is often nonspecific, typically including acute lower abdominal pain, nausea, and vomiting, which can overlap with other abdominal or obstetric conditions, particularly during pregnancy. Imaging modalities, such as ultrasound with Doppler flow assessment, play a supportive role but are not definitive, making timely surgical evaluation essential. The primary treatment goal is prompt surgical intervention to relieve torsion and, whenever feasible, preserve ovarian function. This report describes the case of a 31-year-old primigravida woman presenting at 18 weeks of gestation with right ovarian torsion successfully managed with laparoscopic adnexectomy. CASE REPORT A 31-year-old primigravida woman at 18 weeks of gestation presented with acute right iliac fossa pain, with inconclusive laboratory and imaging results. In the following hours, progression of pain and ultrasound findings revealing a hypovascular adnexal mass led us to suspect ovarian torsion. Diagnostic laparoscopy confirmed right ovarian torsion with extensive necrosis. Following detorsion, the absence of reperfusion indicated irreversible damage, necessitating a right adnexectomy to prevent further complications. CONCLUSIONS Ovarian torsion during mid-pregnancy is uncommon and presents a diagnostic challenge because its symptoms can mimic other obstetric or gastrointestinal conditions. Laparoscopic management, with careful intraoperative modifications for pregnancy, is safe and effective. Early recognition and intervention are critical to minimize maternal and fetal risks while optimizing outcomes.