Adnexal Torsion in Nulligravid Patients: A Case Series

Adnexal torsion is a gynecological emergency that can affect females across all age groups and often presents with nonspecific clinical symptoms, leading to delayed diagnosis and potential loss of ovarian function. We describe two cases of right-sided adnexal torsion occurring in nulligravid patients with associated cystic adnex-al pathology and specific ‘whirlpool sign’ on imaging, with importance of prophy-lactic contralateral Ovariopexy. The first case was a 14-year-old adolescent, presented with acute pelvic pain. Ultra-sonography with color Doppler demonstrated an enlarged right ovary, absent vascu-larity and a whirlpool sign, along with paraovarian cysts. The second case was a 25-year-old woman who developed acute abdominal pain after admission. Imaging find-ings on ultrasonography and magnetic resonance imaging (MRI) were consistent with right adnexal torsion and compromised blood flow. Both patients underwent emergency exploratory laparotomy. Intraoperative findings revealed nonviable adnexa with rotation, necessitating right salpingectomy with cystectomy and prophylactic contralateral ovariopexy. Histopathological examina-tion confirmed ischemic necrosis and inflammatory changes without evidence of ma-lignancy. Postoperative period was uneventful in both cases. These cases highlight the variable clinical presentation of adnexal torsion and em-phasize the importance of maintaining a high index of suspicion in females present-ing with acute pelvic pain. The specific whirlpool sign on imaging is highly diag-nostic of adnexal torsion. Prompt imaging and timely surgical intervention are cru-cial in preventing irreversible ovarian damage and reducing morbidity, especially in nulligravid patients. Prophylactic contralateral Ovariopexy remains important inter-vention to preserve future reproductive function.