Management of Bilateral Dermoid Cysts With Bilateral Torsion During the First Trimester of Pregnancy: A Rare Case Report.

Dermoid tumors of the ovary in reproductive age can get complicated by torsion. We report a case in which bilateral dermoid cysts caused bilateral torsion at eight weeks of pregnancy, necessitating laparotomy as well as left oophorectomy and right cystectomy with a successful obstetric outcome. A 25-year-old G3P2 at eight weeks of gestation presented with severe lower abdominal pain in the left iliac fossa area. Ultrasonography (USG) and magnetic resonance imaging (MRI) revealed bilateral adnexal masses (9.4 cm in the right adnexa and 11 cm in the left adnexa), suggestive of bilateral large dermoid cysts. Failure of conservative management led to the diagnosis of ovarian torsion. Exploratory laparotomy was performed after consenting to oophorectomy. On laparotomy, a large left dermoid cyst was twisted three to four times over its pedicle. The whole ovary was replaced by a dermoid cyst, was discolored, and didn't regain its color after detorsion. Therefore, the left oophorectomy and right cystectomy were done. The post-op period and pregnancy remained uneventful. The patient delivered a female baby vaginally at 39 weeks. Therefore, a high index of suspicion should be for the possibility of acute ovarian torsion in pregnancy with a large dermoid cyst or a bilateral tumor, even in the first trimester. Early surgical intervention in such cases can salvage the ovary and reduce the risk of complications for the mother and fetus.