Acute abdomen in pregnancy: Ovarian torsion diagnosed as hemorrhagic cyst on ultrasonography

Ovarian torsion is not uncommon in pregnancy and presents as one of the causes of acute abdomen in pregnancy. It is more common in the 1st and the early 2nd trimesters but uncommon in the late 2nd and 3rd trimesters. An hemorrhagic cyst has been described as a predisposing factor, and even an imitator of ovarian torsion with ultrasonography been the imaging modality of first choice in its evaluation. The index case is an unusual presentation at the late 2nd trimester gestation, for which ultrasonography revealed a hemorrhagic cyst with normal Doppler findings. However, intraoperative findings were that of an adnexal torsion with infarction warranting salpingo-oophorectomy. Therefore, ultrasonographic findings of hemorrhagic ovarian cyst and relatively normal adnexal Doppler in a pregnant patient with clinical presentation of acute abdomen could highly be suggestive of ovarian torsion, necessitating urgent surgical evaluation and intervention to prevent adnexal infarction.