A case of long-term follow-up of follicular development after laparoscopic retorsion for normal ovarian torsion

Abstract Background Torsion of the normal ovary is a rare condition, although it is relatively common in children. Laparoscopic detorsion and ovarian preservation are standard treatments. However, the decision to preserve the ovary is challenging when severe ischemic discoloration is observed, and its long-term functional outcomes are not well documented. This case report highlights the potential for late functional recovery in a preserved ovary that initially appears nonviable. Case presentation An 11-year-old premenarchal girl presented with acute abdomen. Computed tomography (CT) scan revealed a pelvic mass, leading to a diagnosis of left ovarian torsion. Emergency laparoscopic surgery was performed 35 h after symptom onset. The left ovary was found in the pouch of Douglas, enlarged, and dark purple in color due to torsion. Although there was no significant improvement in color after detorsion, the ovary was preserved as there were no signs of a tumor. Postoperative magnetic resonance imaging (MRI) revealed atrophy of the affected ovary with loss of follicles. However, follow-up MRI one year after surgery demonstrated a return of follicular development. Conclusions Intraoperative appearance, such as color, is not a reliable indicator of ovarian viability, and complete necrosis is rare. Therefore, ovarian preservation should be prioritized over oophorectomy, particularly in children in whom malignancy is rare. This case is novel as it demonstrates the recovery of follicular function one year post-surgery, even after the ovary appeared atrophied. While previous reports often assessed ovarian function at 3–6 months, our findings highlight the importance of long-term follow-up. This case suggests that even severely ischemic ovaries have potential for significant functional recovery. However, its long-term impact on fertility requires further investigation.