{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T04:52:17Z","timestamp":1766119937375,"version":"3.48.0"},"reference-count":17,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,12,3]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>The authors present the case of a multiparous woman, gravida 4, para 2+1, in her late 30s presenting with a 1-day history of acute onset, severe left-sided abdominal pain and nausea at 8 weeks gestation. She was tender on examination, with normal vital signs and a slightly raised C-reactive protein.<\/jats:p>\n                  <jats:p>Transvaginal ultrasound showed a live intrauterine pregnancy with features of left adnexal torsion. The left ovary was enlarged, globular, oedematous and displaced to the pouch of Douglas. It measured about 10 cm with a hypoechoic corpus luteum cyst measuring approximately 9 cm.<\/jats:p>\n                  <jats:p>At emergency laparoscopy, a left large adnexal complex involving a bulky oedematous ovary was seen and twisted four times. No sign of revascularisation was seen after detorsion, and a left salpingo-oophorectomy was done. The histology confirmed a coagulative tissue necrosis. She had an elective caesarean section at 39\u2009weeks gestation with a live baby and no complications.<\/jats:p>","DOI":"10.1136\/bcr-2025-266328","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T04:05:20Z","timestamp":1766117120000},"page":"e266328","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Laparoscopic management of a necrotic left tubo-ovarian torsion in early pregnancy and diagnostic challenges"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7799-6120","authenticated-orcid":false,"given":"Nnadozie","family":"Igbokwe","sequence":"first","affiliation":[{"name":"ST7 Sub-specialist Registrar in Reproductive Medicine, Newcastle Fertility Centre, Newcastle, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shikha","family":"Kapur","sequence":"additional","affiliation":[{"name":"Consultant Obstetrician and Gynaecologist, West Hertfordshire Teaching Hospitals NHS Trust, Watford, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Korycka-Pietras","sequence":"additional","affiliation":[{"name":"ST2 Trainee in Obstetrics and Gynaecology, West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eli","family":"Eagles","sequence":"additional","affiliation":[{"name":"ST3 Registrar in Obstetrics and Gynaecology, Royal Victoria Infirmary, Newcastle upon Tyne, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"key":"2025121820051305000_18.12.e266328.1","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1111\/j.1744-4667.2012.00131.x","article-title":"An update on the diagnosis and management of ovarian torsion","volume":"14","author":"Damigos","year":"2012","journal-title":"Obstet Gynaecologis"},{"key":"2025121820051305000_18.12.e266328.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2012.02.027"},{"key":"2025121820051305000_18.12.e266328.3","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.ajem.2022.12.026","article-title":"Adnexal torsion in pregnancy: A systematic review of case reports and case series","volume":"65","author":"Didar","year":"2023","journal-title":"Am J Emerg Med"},{"key":"2025121820051305000_18.12.e266328.4","doi-asserted-by":"crossref","first-page":"bcr","DOI":"10.1136\/bcr-2012-006755","article-title":"Adnexal torsion in third trimester of pregnancy","volume":"2012","author":"Passarinho","year":"2012","journal-title":"BMJ Case Rep"},{"key":"2025121820051305000_18.12.e266328.5","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijscr.2022.107633","article-title":"Healthy adnexal torsion in pregnancy: A case report","volume":"100","author":"Jalal","year":"2022","journal-title":"Int J Surg Case Rep"},{"key":"2025121820051305000_18.12.e266328.6","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1016\/j.fertnstert.2016.02.010","article-title":"High risk of recurrent torsion in premenarchal girls with torsion of normal adnexa","volume":"105","author":"Smorgick","year":"2016","journal-title":"Fertil Steril"},{"key":"2025121820051305000_18.12.e266328.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2022.03.046"},{"key":"2025121820051305000_18.12.e266328.8","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1002\/uog.21981","article-title":"Imaging in gynecological disease (20): clinical and ultrasound characteristics of adnexal torsion","volume":"56","author":"Moro","year":"2020","journal-title":"Ultrasound Obstet Gynecol"},{"key":"2025121820051305000_18.12.e266328.9","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-020-03173-7"},{"key":"2025121820051305000_18.12.e266328.10","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1002\/jcu.23021","article-title":"Diagnostic value of the sonographic whirlpool sign in the diagnosis of ovarian torsion: A systematic review and meta\u2010analysis","volume":"49","author":"Adu\u2010Bredu","year":"2021","journal-title":"J Clin Ultrasound"},{"key":"2025121820051305000_18.12.e266328.11","unstructured":"Ovarian and fallopian tube torsion. 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