You’re Just Fat”: Diagnostic Overshadowing in Gynecology due to Obesity: A Case Report of 36 cm Ovarian Cyst Causing Torsion

Background: Ovarian cysts are common in premenopausal women but can present with vague, and non-specific symptoms. Additionally, obesity can make discovery even more challenging. Diagnostic overshadowing due to obesity led to misdiagnosis of the presenting symptoms and signs. Most ovarian cysts are benign and resolve spontaneously; however, they can present, as in this case, as ovarian torsions, which is a gynecological emergency. Case presentation: A twenty-year-old female had presented over 3–4 times per year for the last 6 years to her primary doctor citing intermittent abdominal pain, irregular menstruation, dyspnea, and an enlarging abdomen circumference. The doctor stated, she was "just fat" and could, benefit from a "special camp to lose weight", so she stopped mentioning her concerns. Upon presenting to the emergency department with acute onset abdominal pain, a computed tomography scan showed a large cyst lesion filling the abdominal and pelvic cavities. Its origin appeared to be from the left adnexa. Surgery was performed, and an acute ovarian torsion caused by a 36 cm craniocaudal left ovarian cyst was found and removed along with the left fallopian tube and 16 L of fluid. Conclusions. In this case, the patient presented recurring pelvic/abdominal concerns, and irregular menstruation, which warranted further investigation to safeguard fertility and prevent errors of omission. However diagnostic overshadowing due to obesity, hindered the care and standards procedures which could have resulted in early recognition and effective management.