Abstract
Bilateral ovarian torsion is an exceptionally rare condition, especially in postmenopausal women, and presents a diagnostic challenge due to its nonspecific clinical features. Prompt diagnosis and surgical intervention are crucial to prevent ischemic complications. Here, we present the case of a 52-year-old postmenopausal woman who presented with acute abdominal pain and was found intraoperatively to have bilateral ovarian torsion due to the presence of large cysts in both ovaries. Emergency laparotomy was performed, revealing ischemic, necrotic ovaries, necessitating bilateral salpingo-oophorectomy. This case highlights the importance of considering ovarian torsion in the differential diagnosis of acute abdomen in postmenopausal women, especially in those with adnexal cysts, and underscores the role of early surgical intervention.
References
Oltmann SC, Fischer A, Barber R, Huang R, Hicks B, Garcia N. Cannot exclude torsion-a 15-year review. J Pediatr Surg. 2009;44(6):1212–1217.
Hibbard LT. Adnexal torsion. Am J Obstet Gynecol. 1985;152(4):456–461.
Huchon C, Fauconnier A. Adnexal torsion: a literature review. Eur J Obstet Gynecol Reprod Biol. 2010;150(1):8–12.
Cohen A, Solomon N, Almog B, et al. Adnexal Torsion in Postmenopausal Women: Clinical Presentation and Risk of Ovarian Malignancy. J Minim Invasive Gynecol. 2017;24(1):94–97.
Dunnihoo DR, Wolff J.Bilateral torsion of the adnexa: a case report and a review of the world literature. Obstet Gynecol. 1984;64(3 Suppl):55S–59S.
Ahluwalia A, Giga S, Afaghi M. The double bladder sign: Challenges in early sonographic diagnosis of ovarian torsion. Radiol Case Rep. 2022;17(11):4188–4192.
Haskins T, Shull BL. Adnexal torsion: a mind-twisting diagnosis. South Med J. 1986;79(5):576-577.
Al-Harfoushi R, Abdulaziz el-H, Andrabi SI, Patterson B, Whiteside M. Ovarian teratoma presenting as small bowel obstruction in an elderly lady-A case report. Int J Surg Case Rep. 2011;2(1):6-8.
Bodur S, Alanbay I, Karasahin KE, Kinci MF, Fidan U, Keskin U. Chronic Ovarian Torsion Mimicking Subserosal Postmenopausal Fibroid. Eur J Obstet Gynecol Reprod Biol. 2016;206(2016):e137. Available from: https://www.ejog.org/article/S0301-2115(16)30666-2/fulltext
Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics. 2008;28(5):1355–1368.
Wattar B, Rimmer M, Rogozinska E, Macmillian M, Khan KS, Al Wattar BH. Accuracy of imaging modalities for adnexal torsion: a systematic review and meta-analysis. BJOG. 2021;128(1):37-44.
Royal College of Obstetricians and Gynaecologists. Ovarian cysts in postmenopausal women (Green-top Guideline No. 34). London: Royal College of Obstetricians and Gynaecologists; 2016.
Medeiros LR, Rosa DD, Bozzetti MC, et al. Laparoscopy versus laparotomy for benign ovarian tumour. Cochrane Database Syst Rev. 2009;(2):CD004751.
Eitan R, Galoyan N, Zuckerman B, Shaya M, Shen O, Beller U. The risk of malignancy in post-menopausal women presenting with adnexal torsion. Gynecol Oncol. 2007;106(1):211–214.
Galinier P, Carfagna L, Delsol M, et al. Ovarian torsion. Management and ovarian prognosis: a report of 45 cases. J Pediatr Surg. 2009;44(9):1759–1765.
Cusimano MC, Chiu M, Ferguson SE, et al. Association of bilateral salpingo-oophorectomy with all cause and cause specific mortality: population based cohort study. BMJ. 2021;375:e067528.
Taskin O, Birincioglu M, Aydin A, et al. The effects of twisted ischaemic adnexa managed by detorsion on ovarian viability and histology: An ischaemia-reperfusion rodent model. Hum Reprod. 1998;13(10):2823–2827.
Cohen SB, Oelsner G, Seidman DS, Admon D, Mashiach S, Goldenberg M. Laparoscopic detorsion allows sparing of the twisted ischemic adnexa. J Am Assoc Gynecol Laparosc. 1999;6(2):139–143.
Oelsner G, Cohen SB, Soriano D, Admon D, Mashiach S, Carp H. Minimal surgery for the twisted ischaemic adnexa can preserve ovarian function. Hum Reprod. 2003;18(12):2599–2602.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Maria Ntioudi, Georgios Varveris, Katerina Vasiliadou, Alexandra Diamantopoulou