Postpartum ovarian torsion caused by a large mucinous cystadenoma: a rare case study

Abstract

Ovarian torsion is an uncommon cause of abdominal pain, which is the most frequent symptom during pregnancy and the postpartum period. Its diagnosis can be challenging due to its rarity as an obstetric emergency. A high degree of clinical suspicion is essential for timely recognition and intervention to save the ovary and reduce the risk of significant morbidity. A 25-year-old woman, 35 days postpartum, presented with acute onset of severe, sharp abdominal pain and vomiting. On examination, her lower abdomen appeared distended, and a mass corresponding to the size of a 26-week uterus was palpable. The mass was tender, cystic in consistency, and demonstrated lateral mobility. Blood investigations and imaging supported the clinical diagnosis of torsion. Ultrasound revealed a well-defined, thin-walled large adnexal mass with a volume of 1980 cc, and Doppler findings suggested left adnexal torsion. An emergency exploratory laparotomy with left-sided salpingo-oophorectomy was performed due to intraoperative findings of a large, haemorrhagic cystic ovarian mass measuring 18×16×18 cm, with three twists in the pedicle. Histopathology confirmed a mucinous cystadenoma. The patient recovered without complications. This case highlights the importance of clinical suspicion, prompt ultrasound evaluation, and timely surgical intervention in achieving optimal outcomes for patients with ovarian torsion.