MRI Revealing Ovarian Non-salvageable Torsion Masquerading as a Pelvic Mass in a Young Woman With Enterocystoplasty and Neurogenic Bladder.

Adnexal torsion is a gynecological emergency requiring prompt diagnosis and intervention to prevent irreversible ovarian damage. This case report presents a 19-year-old female with a history of spina bifida, neurogenic bladder managed by enterocystoplasty, and chronic urinary retention, who presented with fluctuating pelvic and lumbar pain. Initial ultrasound showed bilateral hydronephrosis without obstruction, while subsequent imaging revealed a pelvic mass with features concerning for ovarian torsion. A non-contrast MRI confirmed a hemorrhagic, non-viable ovary with peripheral microfollicules and a twisted vascular pedicle, establishing the diagnosis of adnexal torsion with infarction. Laparoscopic surgery confirmed the torsion, necessitating oophorectomy due to irreversible ischemic damage. This case underscores the diagnostic challenges posed by atypical presentations, particularly in patients with pre-existing urological conditions. The differential diagnosis includes hemorrhagic ovarian cysts, endometriomas, ectopic pregnancy, and tubo-ovarian abscess, which can mimic torsion. Imaging plays a crucial role in differentiating these conditions and assessing ovarian viability. This report highlights the importance of a structured diagnostic approach, integrating ultrasound, CT, and MRI to optimize timely intervention and preserve ovarian function whenever possible. Radiologists should maintain a high index of suspicion in atypical cases to avoid delays in management and improve patient outcomes.