Torsion of a Large Ovarian Dermoid Cyst in Third Trimester Pregnancy: A Case Report

Abstract

Dermoid cysts are the most frequent ovarian tumours among women of reproductive age, constituting a notable 20% of all adult ovarian tumours. They are typically lined by stratified squamous epithelium and contain dermal and epidermal elements. During pregnancy, dermoid cysts are more likely to lead to infection, rupture and torsion. A 23-year-old multigravida (G2P1L1) female at 36 weeks of gestation presented with complaints of left lumbar pain persisting for one day, unrelieved by medication. Ultrasound (USG)revealed a multiloculated septated cystic lesion in the left lumbar region adjacent to the gravid uterus, just anteroinferior to the left kidney. Magnetic Resonance Imaging (MRI) showed a predominantly fat-density multiloculated cystic lesion with twisting of the pedicle. An emergency laparotomy was performed, and the left ovarian cyst was removed, revealing patchy discolored areas of gangrene, and a live healthy foetus was delivered. While torsion of an ovarian cyst is a well-known complication, its presentation during pregnancy is rare. Due to the variable symptoms of ovarian torsion, the clinical presentation can be quite confusing. Therefore, both the obstetrician and radiologist should have a lower threshold for clinical suspicion of torsion in pregnancy, enabling prompt diagnosis and management of such cases to prevent both maternal and foetal mortality.