Description

A torted ovarian cyst is a gynecological emergency where an ovarian cyst twists around its pedicle, compromising blood supply to the ovary. This torsion can lead to severe abdominal pain, nausea, vomiting, and, if untreated, ischemia and necrosis of ovarian tissue. Prompt diagnosis and surgical management are critical to preserving ovarian function and preventing complications. Clinical Presentation Patients with a torted ovarian cyst often present with: Sudden onset severe lower abdominal or pelvic pain (usually unilateral) Nausea and vomiting due to peritoneal irritation Tenderness and guarding on abdominal examination Possible adnexal mass on imaging Role of Ultrasound Transvaginal or transabdominal ultrasound with Doppler study is the investigation of choice. It can reveal: Enlarged ovary with peripheral cyst Decreased or absent blood flow (though normal flow does not rule out torsion) Free fluid in pelvis Laparoscopic Management Laparoscopy is the gold standard for both diagnosis and treatment of torted ovarian cysts. It offers minimally invasive access, faster recovery, and ovarian preservation compared to open surgery. Steps of Laparoscopic Procedure: Diagnostic Laparoscopy Visualization confirms torsion of the ovary or adnexa. Assessment of viability and presence of cyst. Detorsion of Ovary The twisted ovary is carefully untwisted to restore blood supply. Even if the ovary appears dusky or cyanotic, detorsion should be attempted, as recovery is often possible. Cystectomy The ovarian cyst is excised using laparoscopic instruments while preserving normal ovarian tissue. Hemostasis is secured, and cyst contents are removed using an endobag to prevent spillage. Oophorectomy (if required) If the ovary is nonviable or cyst is suspicious for malignancy, unilateral oophorectomy may be performed. Advantages of Laparoscopic Approach Minimal postoperative pain Faster recovery and shorter hospital stay Cosmetic benefit with small scars Preservation of fertility in young women Postoperative Care Early mobilization and pain management Monitoring for recurrence with follow-up ultrasound Hormonal therapy in selected cases to prevent functional cysts Conclusion Laparoscopic management of a torted ovarian cyst is a safe and effective treatment that allows immediate relief of symptoms, preservation of ovarian function, and quicker recovery. Early surgical intervention is key to preventing irreversible ovarian damage and safeguarding future fertility.