Laparoscopic management of a necrotic left tubo-ovarian torsion in early pregnancy and diagnostic challenges.

The authors present the case of a multiparous woman, gravida 4, para 2+1, in her late 30s presenting with a 1-day history of acute onset, severe left-sided abdominal pain and nausea at 8 weeks gestation. She was tender on examination, with normal vital signs and a slightly raised C-reactive protein.Transvaginal ultrasound showed a live intrauterine pregnancy with features of left adnexal torsion. The left ovary was enlarged, globular, oedematous and displaced to the pouch of Douglas. It measured about 10 cm with a hypoechoic corpus luteum cyst measuring approximately 9 cm.At emergency laparoscopy, a left large adnexal complex involving a bulky oedematous ovary was seen and twisted four times. No sign of revascularisation was seen after detorsion, and a left salpingo-oophorectomy was done. The histology confirmed a coagulative tissue necrosis. She had an elective caesarean section at 39 weeks gestation with a live baby and no complications.