Beyond Ovarian Enlargement: Right Adnexal Torsion Associated with a Constricting Peritoneal Band—A Laparoscopic Case Report with Application of Dr. Sachin's Criteria

Background: Adnexal torsion is an important gynaecological emergency requiring prompt diagnosis and surgical intervention to preserve ovarian function. Although ovarian enlargement and adnexal masses are recognized predisposing factors, unusual anatomical causes may occasionally contribute to torsion. Preoperative diagnosis can be challenging, particularly in patients presenting with nonspecific abdominal symptoms and equivocal imaging findings.

Case Presentation: We report the case of a 30-year-old woman, para 1, with a previous caesarean section and a three-year-old child, who presented with severe lower abdominal pain predominantly localised to the right iliac fossa on 6 October 2026. She also reported an episode of fever three days before presentation and associated backache, without nausea or vomiting.

Considering acute appendicitis and adnexal torsion as differential diagnoses, the patient underwent ultrasonography and magnetic resonance imaging (MRI). MRI demonstrated a bulky right ovary measuring 50 × 48 × 22 mm, with stromal T2 hyperintensity, peripheral displacement of follicles, and relatively reduced stromal enhancement, raising suspicion of torsion-detorsion syndrome. An additional indeterminate enhancing focus was identified in the superomedial aspect of the right ovary.

In view of the clinical and radiological findings, diagnostic and operative laparoscopy was planned. Intraoperatively, right adnexal torsion was identified in association with a bulky ovary showing polycystic morphology. An unusual constricting peritoneal band extending from medial to lateral and encircling the fallopian tube was identified. The band was divided, followed by adnexal detorsion and bilateral utero-ovarian ligament plication according to Dr. Sachin’s Criteria for Adnexal Torsion Management.

The postoperative recovery was uneventful, and the patient was discharged after 24 hours. At 25-day follow-up, she remained asymptomatic.

Conclusion: This case highlights an unusual anatomical association contributing to adnexal torsion and reinforces the importance of diagnostic laparoscopy in patients with persistent clinical suspicion despite equivocal imaging. It also demonstrates the potential application of a structured surgical approach incorporating adnexal detorsion and ligament plication.