Recurrent ovarian torsion challenges in management and saving fertility: A rare case report.

Introduction: Ovarian torsion is a time-sensitive gynecologic emergency that may lead to irreversible ovarian damage. The condition becomes particularly critical in women with a solitary ovary, where timely diagnosis is essential to preserve fertility. Case presentation: A woman of reproductive age with a history of right oophorectomy due to torsion of a mature cystic teratoma presented to the emergency department with acute lower abdominal pain, nausea, and vomiting. Pelvic ultrasound revealed the absence of the right ovary and a complex left ovarian cyst measuring 6 × 6 cm, with signs of congestion. Exploratory laparotomy revealed a twisted, violaceous left ovary measuring approximately 10 × 10 cm with two full twists of the infundibulopelvic (IP) and utero-ovarian (OU) ligaments. Detorsion was performed. Discussion: Current evidence challenges traditional practices of routine oophorectomy in torsion, as histologic studies report preserved viability in 43 % of ovaries despite ischemic appearance. This case reinforces the feasibility of detorsion in reproductive-aged women, particularly those with a solitary ovary, to safeguard fertility. The absence of contralateral ovarian tissue further underscores the need for conservative surgical approaches. Conclusion: This report emphasizes the critical role of early recognition and conservative surgical management in ovarian torsion, especially in patients with a solitary ovary. Timely detorsion can prevent irreversible fertility loss, even in grossly ischemic-appearing ovaries. Patient education about acute pelvic pain and clinician vigilance in high-risk populations are essential to mitigate diagnostic delays.