Ovarian preservation in a pregnant woman with a leaking dermoid cyst and ovarian torsion: a case study and review of diagnostic and therapeutic challenges.

BACKGROUND: Ovarian cysts are common during pregnancy, and dermoid cysts are common benign ovarian tumors, affecting approximately 0.3% of pregnancies, most often detected in the second trimester. Hormonal changes and pressure from the growing uterus can cause these cysts to become symptomatic, leading to complications such as torsion. Torsion presents diagnostic and management challenges, requiring prompt intervention to prevent negative outcomes for both the mother and fetus. In managing ovarian cyst torsion during pregnancy, preserving ovarian tissue is crucial to maintain fertility and endocrine function, especially in women of reproductive age.

CASE PRESENTATION: A 27-year-old primigravida at 18 weeks of gestation presented with acute abdominal pain due to a leaking dermoid cyst with ovarian torsion. Pre-pregnancy imaging had identified a 6-cm dermoid cyst in the right ovary, which was completely twisted with a small cyst rupture and leakage of contents, but with viable ovarian tissue. The appendix was adherent to the cyst at the site of torsion. Detorsion of the ovary, cystectomy with ovarian preservation, and appendectomy were performed. Postoperative care included vaginal progesterone to prevent miscarriage, and she delivered at 39 weeks without complications.

CLINICAL DISCUSSION: Ovarian torsion in pregnancy is a rare but serious condition, occurring in fewer than 4 in 10 000 pregnancies and requiring prompt diagnosis and intervention. The decision between conservative management and surgery depends on factors such as cyst size, gestational age, and associated complications. Laparoscopy is preferred in early pregnancy for its minimally invasive benefits, but laparotomy is often necessary for larger cysts or advanced gestation. This case emphasizes the importance of timely surgical intervention to preserve ovarian function and prevent adverse maternal and fetal outcomes.

CONCLUSION: Managing dermoid cysts in pregnancy requires a delicate balance between timely surgical intervention and minimizing risks to the fetus. This case highlights the importance of individualized management, multidisciplinary collaboration, and early recognition of complications such as ovarian torsion. A structured approach to diagnosis and treatment can lead to successful ovarian preservation and optimal reproductive outcomes.