Adnexal Torsion of a Luteinized Ovarian Cyst in Early Pregnancy: A Case Report and Literature Review.

Ovarian torsion is a gynecological emergency that may occur during pregnancy, particularly during the first trimester, when its symptoms often mimic benign gestational complaints, making diagnosis challenging. Early recognition and timely management are essential to preserve ovarian function and ensure favorable maternal outcomes. We report the case of a 23-year-old primigravida at eight weeks and two days of amenorrhea who presented to the obstetric emergency department with acute pelvic pain without vaginal bleeding. Clinical examination revealed a closed cervical os with no evidence of bleeding. Pelvic ultrasound demonstrated a left ovarian cyst complicated by adnexal torsion. Due to persistent pain, an urgent mini-laparotomy was performed within five hours of symptom onset. Intraoperative findings confirmed adnexal torsion, and conservative surgical management consisting of detorsion and cystectomy was successfully achieved with preservation of the ovary. The postoperative course was uneventful, with ongoing favorable pregnancy evolution. This case highlights the increased risk of ovarian torsion during early pregnancy due to hormonal and anatomical changes, particularly the presence of corpus luteum cysts and increased adnexal mobility. Because clinical presentation is often nonspecific, ultrasound with Doppler remains the imaging modality of choice. Prompt surgical intervention should not be delayed, and ovarian preservation is frequently feasible and desirable in young patients to maintain future reproductive potential.