On examination, the patient was found to have a large ovarian cyst measuring approximately 20 centimeters, extending up to the umbilicus. The severity of her pain and clinical findings suggested ovarian torsion, a condition where the cyst twists at its base, leading to compromised blood supply and acute pain. Dr. Indrani Salunkhe, Gynaecologist at Wockhardt Hospitals, led the diagnosis and treatment of this case.

To rule out endometriotic cysts or malignancy, a CA-125 blood test was performed. The results were within normal limits, confirming that the cyst was simple in nature. Further imaging with sonography and a CT scan confirmed the diagnosis of ovarian torsion and revealed the cyst’s large size and position within the abdomen.

The patient was diagnosed with a large, simple ovarian cyst complicated by torsion. This condition required immediate surgical intervention to relieve the torsion, preserve ovarian function, and prevent further complications.

Given the patient’s young age and recent marriage, Dr. Indrani Salunkhe opted for a laparoscopic approach to minimize scarring and ensure a faster recovery. This approach would also be beneficial if the patient planned to conceive in the near future.

1. Creating Access for Laparoscopy: The size of the cyst (20 centimetres) presented a challenge, as large cysts often limit the space available to safely insert a Veress needle for creating pneumoperitoneum. However, in this case, there was still sufficient space (1-2 centimeters) to proceed with the laparoscopic approach.

2. Deflating the Cyst: To create working space and facilitate removal, a trocar was directly inserted into the cyst, and the fluid collected inside was carefully suctioned out. This deflation caused the cyst to collapse, making it manageable laparoscopically.

3. Untwisting the Ovary: The ovary, which had twisted at its base due to the cyst’s weight, was carefully untwisted to restore blood supply and prevent permanent damage.

4. Cystectomy: The cyst wall was meticulously separated from the ovary and excised. Since the cyst was simple and contained only clear fluid, the ovary was successfully preserved.

Outcome:

The surgery was completed without complications under the skilled expertise of Dr. Indrani Salunkhe. The patient’s ovary was saved, and she was discharged the following day with minimal postoperative discomfort. After one week, she returned for suture removal and reported no further issues. The patient is currently trying to conceive, and her reproductive health remains intact.

Large ovarian cysts often develop due to untreated hormonal imbalances, particularly in patients with polycystic ovarian disease (PCOD). Hormonal changes beginning at puberty can trigger cyst formation, which may progress over time if undetected or untreated. In this case, the cyst likely developed over a prolonged period, eventually leading to torsion.

Torsion occurs when the weight and size of a cyst cause it to twist at its base, cutting off blood supply to the ovary and resulting in severe pain. Early detection and intervention are critical to prevent irreversible ovarian damage. This case underscores the importance of timely medical evaluation for symptoms such as severe menstrual pain, heavy clotting, or irregular periods.

This case highlights the importance of early diagnosis, advanced imaging, and timely surgical intervention in managing large ovarian cysts with torsion. Under the expert care of Dr. Indrani Salunkhe, laparoscopic surgery not only ensured a positive surgical outcome but also preserved the patient’s fertility potential. Women experiencing severe menstrual symptoms or irregularities should seek prompt medical evaluation to prevent complications such as torsion or the development of large ovarian cysts