Abstract
Adnexal torsion during pregnancy is rare and is complicated by ambiguous symptoms and often nonspecific imaging findings. Differential diagnoses of torsion include a ruptured ovarian cyst, tubo-ovarian abscess, and appendicitis. A low threshold for the recommended surgical laparoscopy is necessary to avoid delayed diagnosis and fetal or maternal complications. We present a case of a 30-year-old woman at 10 weeks gestation as a surrogate carrier, admitted for progressive, sharp lower right quadrant abdominal pain. On presentation, she was afebrile and vitally stable, with moderate leukocytosis and elevated inflammatory markers. Transvaginal ultrasound showed a 6 x 6 cm adnexal mass/cyst, without ovarian vascular compromise, in addition to a tubular structure indicating possible hydrosalpinx. Initially, her presenting symptoms partially resolved following antibiotics and analgesics, which led us to consider a tubo-ovarian abscess as the culprit. However, upon a recurrence of pain, we proceeded with a diagnostic laparoscopy, with a high suspicion of ovarian torsion. A right adnexal torsion and paratubal cyst were identified; detorsion with preservation of adnexa and cystectomy was performed, with resolution of the pain in the postoperative period. This case underscores the importance of identifying multiple risk factors and complex clinical scenarios for ovarian torsion in premenopausal patients in the context of surrogate pregnancies following tubal ligation. Our findings contribute to the existing literature by emphasizing the need for a high index of suspicion for adnexal torsion, as it is imperative to prevent complications and ensure prompt surgical intervention.