Ultrasonographic whirlpool sign in ovarian torsion with dual mature teratomas: A case report and literature review

Adnexal torsion is a gynecological emergency resulting from the partial or complete rotation of the ovary, often involving the fallopian tube, around its vascular pedicle. Prompt diagnosis is crucial to prevent ischemic injury and preserve ovarian function. Mature cystic ovarian teratomas are common benign neoplasms and represent a frequent cause of torsion due to their size, mobility and mass effect. The present case report describes the case of a 36‑year‑old woman (gravida 2, para 2) who presented several hours following the sudden onset of right lower abdominal pain, initially accompanied by nausea, both of which had resolved by the time of evaluation. A transvaginal ultrasonography revealed a right ovarian mass measuring 6.13x5.20 cm, containing two mature cystic teratomas. Gray‑scale and color Doppler imaging clearly demonstrated the characteristic whirlpool sign, indicating torsion of the adnexal vascular pedicle. An emergency laparoscopy revealed the quadruple torsion of the adnexa (fallopian tube and ovary), and a right salpingo‑oophorectomy was performed, as the patient had completed her family. The post‑operative course of the patient was uneventful. A post‑operative pathological examination confirmed the torsion of mature ovarian teratomas with associated hemorrhagic necrosis. On the whole, the present study demonstrates that the ultrasonographic whirlpool sign is a highly specific pre‑operative marker for adnexal torsion, particularly in cases with multiple mature cystic teratomas. Early recognition facilitates prompt surgical intervention, minimizes ischemic injury, and may preserve ovarian function. Incorporating the focused assessment of the whirlpool sign into routine ultrasonography for acute pelvic pain enhances diagnostic accuracy and guides timely operative management.