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

BACKGROUND: Torsion of a morphologically normal ovary is rare, though relatively more frequent in pediatric patients. Laparoscopic detorsion with ovarian preservation is the standard treatment; however, intraoperative decisions are often difficult when the ovary appears severely ischemic. Evidence on the long-term functional outcomes of preserved, ischemic-appearing ovaries remains limited. This case highlights the potential for delayed recovery of follicular function even when early imaging suggests atrophy. CASE PRESENTATION: An 11-year-old premenarchal girl presented with acute abdominal pain, vomiting, and low-grade fever. Abdominal computed tomography (CT) revealed a non-enhancing pelvic mass, raising suspicion of ovarian torsion. Emergency laparoscopy, performed 35 h after symptom onset, revealed a 720° counterclockwise torsion of the left ovary, which was enlarged, dark purple, and located in the pouch of Douglas. Despite the lack of visible reperfusion following detorsion, the ovary was preserved given the absence of neoplastic findings and the patient's young age. Postoperative magnetic resonance imaging (MRI) at one month and six months demonstrated progressive atrophy of the affected ovary with complete loss of follicles, strongly suggesting necrosis. Unexpectedly, at 1 year post-surgery, MRI showed renewed follicular development and restoration of ovarian volume. By 2 years, additional follicles were observed. CONCLUSIONS: Intraoperative appearance alone is not a reliable predictor of ovarian viability, and complete necrosis is uncommon. This case demonstrates that even severely ischemic ovaries may regain function after prolonged intervals, emphasizing the importance of ovarian preservation and extended follow-up in pediatric torsion cases. The long-term implications for fertility, however, require further study.