Ovarian torsion mimicking subacute intestinal obstruction: a rare case report

Abstract

Ovarian torsion is a time-sensitive gynaecological emergency resulting from rotation of the ovary, with or without the fallopian tube, around its vascular pedicle. Delayed diagnosis may lead to ischemia, necrosis and loss of ovarian function. Although the condition typically presents with acute unilateral pelvic pain, atypical manifestations may resemble gastrointestinal disorders, creating diagnostic uncertainty and delaying appropriate management. A 29-year-old multiparous woman presented with sudden-onset left iliac fossa pain, progressive abdominal distension, obstipation for four days and recurrent episodes of non-bilious vomiting, suggestive of subacute intestinal obstruction. Her medical history was significant for ovulation induction complicated by ovarian hyperstimulation syndrome and previous pelvic surgeries, including right salpingo-oophorectomy. Initial radiological evaluation demonstrated features of intestinal obstruction with a large left adnexal lesion. Magnetic resonance imaging revealed an enlarged oedematous left ovary with a twisted vascular pedicle demonstrating the characteristic whirlpool sign, consistent with ovarian torsion. Emergency surgical exploration identified a gangrenous left Tubo-ovarian complex twisted approximately 2.5 turns with associated hemoperitoneum and dense pelvic adhesions. Left salpingo-oophorectomy was performed. Histopathological examination confirmed haemorrhagic infarction with extensive congestion, oedema and coagulative necrosis. The postoperative recovery was uneventful. Ovarian torsion presenting as intestinal obstruction is an uncommon clinical entity. Gastrointestinal symptoms may predominate due to bowel compression, reactive ileus, or adhesion-related obstruction, masking the underlying gynaecological pathology. In such cases, MRI findings, particularly identification of the whirlpool sign, play an important role in establishing the diagnosis and facilitating timely surgical intervention. Ovarian torsion should remain an important differential diagnosis in reproductive-age women presenting with unexplained gastrointestinal symptoms accompanied by an adnexal mass. Early recognition, appropriate imaging and prompt surgical management are essential to reduce morbidity and maximize the possibility of ovarian preservation.