Twisted ovarian cyst in postmenopausal woman: A case report

Introduction: Twisted ovarian cysts are acute conditions that cause sudden pain in the lower abdomen and may occur in older people. A twisted ovarian cyst presents as a complex cyst picture on ultrasound and CT scans and may mimic malignant ovarian masses. A normal CA-125 level in an older woman with a complex ovarian cyst who presents with acute pelvic pain may indicate a twisted ovarian cyst. Case presentation: A 62-year-old woman presented with acute pelvic pain. A CT scan revealed a cystic ovarian mass with a diameter of 15,1 cm x 10,2 cm x 11,2 cm. Additionally, thick septations and multiple projected mural nodules were detected with normal CA-125 levels. Discussion: The patient underwent an exploratory laparotomy. Subsequently, a midline incision was made and 100 ml of hemorrhagic ascites was observed. Macroscopic examination of the left ovary revealed an ovarian cyst with necrosis and bleeding, weighing 830 g, and measuring 15 × 12 × 8 cm. Histopathological examination of the cyst revealed serous cystadenoma. Conclusion: This case suggests that a twisted ovarian cyst may occur in old age; therefore, in older women with complaints of sudden pain in the lower abdomen, a twisted ovarian cyst should be suspected. In post-menopausal women, ovarian masses may not be indicative of a malignancy. However, a twisted benign ovarian cyst should be considered if a complex ovarian mass with acute pelvic pain and normal CA-125 levels is found.