Laparoscopic Management of Ovarian Torsion in the Third Trimester of Pregnancy: A Case Report and Literature Review.

Adnexal torsion in pregnancy is an uncommon surgical emergency that may compromise both ovarian viability and pregnancy outcome. Diagnosis in late gestation is particularly challenging because of nonspecific symptoms and displacement of the adnexa. Although laparoscopy is well established in early pregnancy, evidence supporting its use in the third trimester remains limited. We report a case of ovarian torsion occurring at 30 + 1 weeks of gestation that was successfully managed laparoscopically using pregnancy-adapted techniques. The patient presented with acute abdominal pain, and imaging revealed a right adnexal mass with no detectable intraovarian arterial or venous flow. Emergency laparoscopy was performed within a few hours of admission. Abdominal access was achieved using a 10-mm optical trocar placed under ultrasound guidance approximately 6 cm above the uterine fundus, and pneumoperitoneum was reduced to 12 mmHg after initial access. Detorsion restored the appearance of ovarian perfusion, and ovarian-sparing cystectomy was performed for the underlying mature cystic teratoma. Postoperative recovery was uneventful, the pregnancy progressed to spontaneous term delivery, and postpartum ultrasonography demonstrated normal right-ovarian morphology with preserved vascularization. A focused review identified only a limited number of comparable laparoscopic cases at or beyond 28 weeks of gestation. This case adds to the limited evidence supporting individualized laparoscopic management of ovarian torsion in late pregnancy when pregnancy-specific precautions and multidisciplinary expertise are available.