Autoamputation of the ovary after missed diagnosis of ovarian dermoid cyst torsion: a case report and review of literature

Abstract

Torsion is the most frequent complication of ovarian dermoid cysts. Adnexal torsion typically presents as a severe abdominal pain and is treated as an acute surgical emergency. However, if surgery is delayed or the diagnosis is not made in a timely manner, autoamputation of the ovary is a very rare, but possible, complication. Herein, we report a case of an autoamputated ovary with a dermoid cyst and review the literature. A 33-year-old patient presented with pelvic pain lasting three weeks and was scheduled for a laparoscopy due to the presence of bilateral ovarian cysts, with a dermoid cyst identified on the left ovary. During the procedure, it was discovered that both the left fallopian tube and ovary were absent. The infundibulo-pelvic ligament appeared to terminate abruptly at the pelvic brim. Moreover, an 8 cm pelvic mass was found lodged in the cul-de-sac, which was extensively adherent to the bowel and the uterus, and was covered by vascular omental tissue. Histopathological analysis revealed that this pelvic mass was a dermoid cyst. The cyst contained adipose tissue, hair, and microscopic ovarian stroma, confirming the diagnosis. This case highlights the complexity of diagnosing and managing pelvic masses. Clinicians should maintain a high index of suspicion for ovarian torsion and consider the possibility of autoamputation when an ovary is not found in its anatomical location, especially if imaging suggests the presence of a dermoid cyst. This case also underscores the importance of meticulous surgical dissection for the complete removal of such masses.