Giant Ovarian Torsion in a 77-Year-Old Postmenopausal Woman: Diagnostic Challenges and Surgical Management in a Low-Resource Setting

Background: Ovarian torsion is an uncommon gynecological emergency in postmenopausal women.Its presentation is often atypical, particularly when associated with giant ovarian cysts, leading to delayed diagnosis and increased morbidity.Case presentation: A 77-year-old postmenopausal woman presented with progressive lower abdominal pain over two weeks, which became severe and was associated with nausea, vomiting, and abdominal distension.Clinical examination revealed a large mobile abdominal mass extending above the umbilicus.Ultrasonography demonstrated a giant complex right adnexal mass with ovarian enlargement, heterogeneous internal echoes, absent Doppler flow, and a twisted vascular pedicle (whirlpool sign).Emergency laparotomy revealed a giant torsed ovarian mass with ischemic and necrotic changes.Total abdominal hysterectomy with bilateral salpingooophorectomy was performed.Histopathology confirmed a benign mucinous cystadenoma.Conclusions: Although rare, ovarian torsion should be considered in postmenopausal women presenting with acute or subacute abdominal pain and adnexal masses.Early surgical intervention is essential, particularly in low-resource settings where advanced imaging is unavailable.