Partial autoamputation of an ovary following adnexal torsion with preserved ovarian function in a reproductive-age woman: A case report and literature review

Partial autoamputation of an ovary following adnexal torsion with preserved ovarian function in a reproductive-age woman: A case report and literature review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Partial autoamputation of an ovary following adnexal torsion with preserved ovarian function in a reproductive-age woman: A case report and literature review Kino Hayashi, Hideaki Tsuyoshi, Akari Nakamori, Michio Watanabe, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8726570/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 23 You are reading this latest preprint version Abstract Background Ovarian autoamputation is a rare consequence of prolonged adnexal torsion and is generally associated with irreversible loss of ovarian and tubal function on the affected side. Preoperative diagnosis is challenging, and fertility preservation is rarely achievable once autoamputation has occurred. To date, no cases with preserved ipsilateral ovarian function after autoamputation have been reported. Case: A 29-year-old woman with a known benign-appearing left ovarian tumor presented with acute lower abdominal pain. Imaging studies suggested torsion of the ovarian tumor pedicle, and emergency laparoscopic surgery was performed. Intraoperatively, a necrotic, fist-sized mass consistent with an autoamputated ovarian tumor was identified in the pouch of Douglas, while the remaining ovary and fallopian tube were preserved. Histopathological examination revealed hemorrhagic infarction and necrosis of the tumor, with residual ovarian stroma containing follicles. Postoperative follow-up demonstrated normal follicular development and resumption of regular menstruation, confirming preserved ovarian function on the affected side. Conclusion This report describes the first documented case of partial ovarian autoamputation secondary to adnexal torsion with preservation of ipsilateral ovarian function. The findings suggest that spontaneous detachment of necrotic tissue does not inevitably result in complete loss of ovarian function. In reproductive-age women, early surgical intervention should be strongly considered when adnexal torsion is suspected, even in the absence of definitive imaging findings, to maximize the potential for fertility preservation. ovarian tumor pedicle torsion autoamputated ovary laparoscopic surgery preserved ovary follicular development Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Background Ovarian pedicle torsion is a well-recognized gynecological emergency, accounting for approximately 2.7% of all acute gynecologic conditions and ranking fifth in frequency among such emergencies ( 1 , 2 ). Although it can occur across all age groups, it predominantly affects women of reproductive age, with nearly 30% of reported cases occurring in individuals younger than 20 years ( 3 , 4 ). The condition arises when the adnexa twist around the axis formed by the ovarian and infundibulopelvic ligaments, leading to compromised vascular flow ( 3 ). While torsion may occur in morphologically normal ovaries, the risk is substantially increased in the presence of adnexal masses, particularly those exceeding 5 cm in diameter ( 5 ). An autoamputated ovary is a rare clinical entity, defined as the spontaneous detachment of a normal ovary or an ovarian tumor following prolonged pedicle torsion ( 6 ). The reported incidence is extremely low, estimated at approximately 1 in 11,421 cases ( 7 ). It is postulated that sustained torsion results in ischemia and subsequent necrosis, ultimately leading to separation of the necrotic adnexal tissue due to complete disruption of the distal blood supply ( 8 , 9 ). In most cases, the diagnosis is made intraoperatively upon the unexpected absence of an ovary, accompanied by a blindly ending fallopian tube lacking fimbriae or an identifiable infundibulum ( 10 , 11 ). Preoperative diagnosis remains challenging, as no definitive imaging criteria have been established. Once autoamputation has occurred, therapeutic options are limited, and irreversible loss of ovarian function on the affected side is generally assumed, raising significant concerns regarding fertility preservation ( 6 , 10 ). Herein, we report an exceptionally rare case in which ovarian pedicle torsion led to spontaneous detachment of an ovarian tumor with only partial autoamputation of the ovary. Remarkably, residual ovarian tissue with preserved function remained on the affected side, allowing for potential fertility preservation. To our knowledge, this is the first reported case of partial ovarian autoamputation in a reproductive-age woman with maintained ipsilateral ovarian function. This case provides novel insight into the pathophysiology of ovarian torsion and highlights the possibility of fertility preservation even after severe torsional events. Case Presentation A 29-year-old woman, gravida 1 para 0 (one prior induced abortion), presented with a regular menstrual cycle occurring every 30 days and lasting 4–7 days. Her medical history included acute appendicitis at the age of 27, which was treated conservatively, and pelvic peritonitis secondary to Chlamydia trachomatis infection at the same age. During a routine gynecological examination by her previous physician, a multilocular left ovarian tumor measuring 6.5 cm in diameter was detected. The patient requested surgical management and was referred to our department. Contrast-enhanced magnetic resonance imaging (MRI) demonstrated a 6.5 cm multilocular cystic mass in the left ovary, showing low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. No solid components or mural thickening suggestive of malignancy were identified, and the lesion was suspected to be a mucinous cystadenoma (Fig. 1 ). The patient had severe obesity (body mass index, 37 kg/m²; height, 156 cm; weight, 90 kg) and poorly controlled type 2 diabetes mellitus (HbA1c, 9.2%). In consideration of the increased perioperative risk, surgical intervention was deferred, and medical optimization was prioritized. The ovarian tumor was monitored at three-month intervals, during which no change in size was observed. Nine months after the initial consultation, the patient presented to the emergency department with persistent left lower abdominal pain that had begun the previous evening. She reported experiencing intermittent episodes of similar pain in the past, which had resolved spontaneously. Her last menstrual period had occurred 20 days prior and lasted four days, and her most recent sexual intercourse had been one week earlier. At presentation, torsion of the known left ovarian tumor was suspected, and she was referred to our department. Her vital signs were stable: heart rate 119 beats/min, blood pressure 110/80 mmHg, respiratory rate 16/min, body temperature 36.9°C, and oxygen saturation 98% on room air. On pelvic examination, marked tenderness was noted in the left lower abdomen, and a soft mass was palpated in the left adnexal region. Mild uterine tenderness and persistent reddish vaginal discharge were observed on speculum examination. Transvaginal ultrasonography revealed no abnormalities in the endometrium or right adnexa, while a multilocular cyst measuring 7.5 × 5.5 cm was identified in the left adnexal region. Laboratory tests showed mild inflammatory changes, with a white blood cell count of 11,260/µL and a C-reactive protein level of 3.496 mg/dL. Tumor markers CEA and CA19-9 were within normal limits (CEA < 1.00 ng/mL; CA19-9, 3.4 U/mL), whereas CA125 was mildly elevated (54.3 U/mL). A pregnancy test was negative. Contrast-enhanced computed tomography (CT) demonstrated a 7.5-cm multilocular cystic mass in the left ovary with wall thickening and poor contrast enhancement (Fig. 2 ). No mural nodules or solid components were identified, and there were no findings suggestive of malignancy. A whirlpool sign involving the left ovarian artery and vein was observed, consistent with adnexal torsion (Fig. 3 ). No abnormalities were detected in other intra-abdominal organs. Based on these findings, emergency laparoscopic surgery was performed under general anesthesia. Intraoperatively, the left ovary was found to be severely lacerated and covered with blood (Fig. 4 ). The left fallopian tube, proper ovarian ligament, and infundibulopelvic ligament were markedly congested and edematous. A black, fist-sized mass was identified in the pouch of Douglas (Fig. 5 ). The uterus, right ovary, and right fallopian tube appeared normal (Fig. 6 ), and no ascites or additional intra-abdominal abnormalities were noted. The mass in the pouch of Douglas exhibited no adhesions to surrounding tissues and showed no communication with adjacent organs (Fig. 7 ). After confirming hemostasis of the residual left ovary, the mass was excised, and the procedure was completed laparoscopically. The total operative time was 1 hour and 33 minutes, with an estimated blood loss of 100 mL. Gross examination of the excised specimen revealed a cyst containing brown to reddish-brown serohemorrhagic fluid. The cyst wall was smooth, without nodules or solid components, and the boundary between the cyst wall and ovarian stroma was indistinct (Fig. 8 ). Histopathological examination demonstrated widespread hemorrhagic infarction and edema, consistent with ischemic necrosis. Most of the cyst wall was necrotic, preventing evaluation of the epithelial lining. Focal neutrophilic infiltration suggested an acute inflammatory process, and marked fibrin deposition on the cyst surface indicated acute disruption of blood flow. Notably, ovarian stromal tissue containing follicles was identified in a localized area of the cyst wall (Fig. 9 ). Based on the pathological findings and clinical course, the mass in the pouch of Douglas was diagnosed as a necrotic ovarian tumor resulting from partial autoamputation secondary to torsion of the left ovarian tumor pedicle. The postoperative course was uneventful, with no signs of infection. The patient was discharged on postoperative day 6. One month after surgery, transvaginal ultrasonography demonstrated follicular development in the affected ovary (Fig. 10 ), and normal menstruation resumed. At six months of follow-up, there was no evidence of tumor recurrence. Discussion Ovarian autoamputation represents a rare but clinically significant sequela of prolonged or repeated adnexal torsion. It is generally regarded as the terminal stage of ischemic injury, resulting in irreversible loss of ovarian and often tubal function on the affected side. The present case challenges this conventional understanding by demonstrating that partial autoamputation can occur with preservation of residual ovarian tissue and function, thereby expanding current knowledge regarding the pathophysiology and reproductive implications of adnexal torsion. Preoperative diagnosis of adnexal torsion and subsequent autoamputation remains difficult because of nonspecific clinical symptoms and limitations of imaging modalities. Transvaginal ultrasonography is the first-line diagnostic tool for evaluating adnexal pathology and is frequently combined with laboratory testing and tumor marker assessment to exclude malignancy ( 8 , 31 ). However, preserved ovarian blood flow on Doppler imaging does not exclude torsion, as normal flow has been reported in up to 60% of torsion cases ( 3 , 6 ). Contrast-enhanced computed tomography is often used in emergency settings but has lower sensitivity for torsion detection and involves radiation exposure ( 32 ). Magnetic resonance imaging provides superior soft-tissue resolution and higher specificity for ovarian torsion, particularly in the presence of adnexal tumors ( 33 ). Nonetheless, its limited availability in emergency situations restricts routine use ( 34 ). Consequently, no imaging modality alone can reliably diagnose adnexal torsion or autoamputation, and clinical judgment remains essential ( 3 ). Inflammatory markers such as leukocyte count and C-reactive protein may be elevated but lack diagnostic specificity ( 9 , 26 ). In the present case, serial imaging initially suggested a benign ovarian tumor, while emergency CT demonstrated indirect signs of torsion, including the whirlpool sign. Despite these findings, partial autoamputation could not be diagnosed preoperatively. This underscores the importance of maintaining a high index of suspicion and considering early surgical exploration when torsion is clinically suspected, regardless of equivocal imaging results. An autoamputation of the ovary is believed to result from sustained or intermittent torsion leading to ischemia, hemorrhagic infarction, and necrosis. In some cases, the necrotic ovary or tumor detaches completely and may subsequently reimplant on adjacent structures, such as the omentum or bowel, potentially developing collateral blood supply ( 6 ). However, the precise mechanisms underlying detachment and engraftment remain incompletely understood. In the present case, histopathological examination revealed widespread hemorrhagic infarction, fibrin deposition, and focal inflammatory infiltration, indicating acute ischemic necrosis. Importantly, ovarian stromal tissue containing follicles was identified in a localized area of the cyst wall, suggesting that ischemic damage was not uniform. We propose that torsion of the ovarian tumor pedicle led to necrosis and detachment of the tumor itself, while spontaneous detorsion occurred before irreversible ischemia developed in the remaining ovary and fallopian tube. Residual edema of the adnexal ligaments observed intraoperatively supports this hypothesis. To contextualize this case, we conducted a comprehensive review of published case reports of autoamputated ovaries in women of reproductive age between 2016 and 2025 (Table 1 ). Fourteen cases were identified. Abdominal or pelvic pain was the most common presenting symptom, occurring in 50% of cases, whereas 36% were asymptomatic and diagnosed incidentally during unrelated surgical procedures. Less common presentations included secondary amenorrhea, vomiting, and inflammatory symptoms. Notably, in all reported cases, including the present one, the diagnosis of autoamputation was made intraoperatively, highlighting the absence of reliable preoperative diagnostic criteria. Table 1 Literature review of autoamputated ovaries in women of reproductive age, published between 2016 and 2025. No. Year Study Age Symptoms Diameter (mm) Pathology Side Ovary Fallopian tube Parasite function of the affected adnexa 1 2016 Murphy( 28 ) 34 Infertility ー Hydrosalpinx R intact partial amputation Free Lost 2 2017 Kim( 21 ) 34 mass 60 MCT L complete amputation complete amputation Free Lost 3 2017 John( 24 ) 32 Sterization 60 MCT L complete amputation partial amputation pouch of Douglas, rectum Lost 4 2017 Atici( 9 ) 16 Abd pain 20 MCT R complete amputation partial amputation Free Lost 5 2019 Durous( 14 ) 26 Lower back pain 30 Fibroma R complete amputation complete amputation Free Lost 6 2021 Daccache( 12 ) 42 mass 20 MCT L complete amputation Unknown Free Lost 7 2022 Habek( 26 ) 24 Abd pain 70 simple cyst L complete amputation complete amputation Free Lost 8 2022 Atileh( 1 ) 26 Abd pain 130 Endometrioma L partial amputation complete amputation Free Lost 9 2023 Gorginzadeh( 18 ) 14 mass 100 MCT L complete amputation complete amputation within the omentum Lost 10 2023 Chaichain( 15 ) 46 amenorrhea 50 MCT R complete amputation complete amputation Free Lost 11 2023 Ellison ( 25 ) 31 Abd pain 50 Unknown L complete amputation complete amputation Free Lost 12 2024 Mariam S( 8 ) 28 mass 60 simple cyst R intact partial amputation Free Lost 13 2025 Ayşe Seyhan( 23 ) 33 Abd pain 80 MCT L complete amputation complete amputation pouch of Douglas Lost 14 2025 Our case 29 Abd pain 75 MCA L partial amputation intact Free Preservation MCT, Mature cystic teratoma: MCA, Mucinous cystic adenoma Post-autoamputation implantation of ovarian tissue was reported in 21% of cases, most frequently in the pouch of Douglas, omentum, or sigmoid colon. Mature cystic teratoma was the most common pathological diagnosis, accounting for 50% of cases, followed by fibromas, simple cysts, endometriotic cysts, and torsion associated with hydrosalpinx. Tumor size ranged from 2 to 13 cm, with a slight predominance of left-sided involvement. Crucially, in all reviewed cases except the present one, reproductive potential on the affected side was irreversibly compromised. The fallopian tube was either blind-ending due to loss of fimbriae or entirely absent, and in 71% of cases the ovary was completely missing. These findings support the prevailing view that autoamputation typically represents a catastrophic event for fertility. In contrast, our case uniquely demonstrated preservation of both ovarian tissue and tubal continuity, with postoperative follicular development confirming retained ovarian function. Autoamputation of the ovary is believed to result from sustained or intermittent torsion leading to ischemia, hemorrhagic infarction, and necrosis (Fig. 11 ). In some cases, the necrotic ovary or tumor detaches completely and may subsequently reimplant on adjacent structures, such as the omentum or bowel, potentially developing collateral blood supply ( 6 ). However, the precise mechanisms underlying detachment and engraftment remain incompletely understood. In the present case, histopathological examination revealed widespread hemorrhagic infarction, fibrin deposition, and focal inflammatory infiltration, indicating acute ischemic necrosis. Importantly, ovarian stromal tissue containing follicles was identified in a localized area of the cyst wall, suggesting that ischemic damage was not uniform. We propose that torsion of the ovarian tumor pedicle led to necrosis and detachment of the tumor itself, while spontaneous detorsion occurred before irreversible ischemia developed in the remaining ovary and fallopian tube. Residual edema of the adnexal ligaments observed intraoperatively supports this hypothesis (Fig. 12 ). Conclusion This report describes the first documented case of partial ovarian autoamputation secondary to torsion of an ovarian tumor pedicle with preservation of ipsilateral ovarian and tubal function. While ovarian autoamputation is generally associated with irreversible loss of fertility, this case demonstrates that spontaneous detachment of necrotic tissue does not inevitably result in complete loss of ovarian function. Clinicians should be aware of the diagnostic limitations of imaging and the potential for atypical clinical courses. In reproductive-age women, early surgical intervention remains critical to maximizing the possibility of fertility preservation. Abbreviations HbA1c, hemoglobin A1c; MRI, magnetic resonance imaging; CT, computed tomography; SpO2, saturation of percutaneous oxygen; WBC, white blood cell; CRP, C-reactive protein; CEA, carcinoembryonic antigen; CA19-9: carbohydrate antigen 19-9; CA125, cancer antigen 125 Declarations Ethics approval and consent to participate This report was approved by the Hospital Ethics Committee of the University of Fukui. Consent for publication In accordance with ethical guidelines, written informed consent for publication of this case report and accompanying images was obtained from the patient. Availability of data and materials The data supporting the findings of this study are available within the article. Competing interests The authors declare no conflicts of interest. Funding Not applicable. Authors' contributions KH, AN, NW, and TH performed surgeries. KH, HT, AN, and YH were involved in data acquisition and preparation of the figures. KH and HT wrote the manuscript. MO and YY proofread and revised the manuscript. All authors have read and approved the final manuscript. Acknowledgements Not applicable. References Atileh LIA, Khalifeh NMD. Fallopian tube autoamputation after acute large endometrioma torsion. Gynecol Minim Invasive Ther. 2022;11(2):124–6. Sankaran S, Shahid A, Odejinmi F. Autoamputation of the fallopian tube after chronic adnexal torsion. J Minim Invasive Gynecol. 2009;16(2):219–21. Sasaki KJ, Miller CE. Adnexal torsion: review of the literature. J Minim Invasive Gynecol. 2014;21(2):196–202. Ashwal E, Hiersch L, Krissi H, et al. Characteristics and management of ovarian torsion in premenarchal compared with postmenarchal patients. Obstet Gynecol. 2015;126(3):514–20. Ghosh A, McKay R. A missed diagnosis of ovarian torsion in a patient with bilateral ovarian dermoid cysts: a case report. Cureus. 2019;11(10):5963. Lee KH, Song MJ. In Cheul Jung, Yong Seok Lee & Eun Kyung Park, Autoamputation of an ovarian mature cystic teratoma: a case report and a review of the literature: World J Surg Oncol. :2016;14(1):217. Sivanesaratnam V. Unexplained unilateral absence of ovary and fallopian tube. Eur J Obstet Gynecol Reprod Biol. 1986;22:103–5. Mariam S, Banoub EM, Konrath BA, Khan, Rayan A, Elkattah. Spontaneous Autoamputation Adnexa CRSLS. 2024;11(3):e202400025. Atıcı A, Yılmaz E, Karaman A, Apaydın S, Afşarlar. Ç.E. Tuba-ovarian auto-amputation caused by ovarian teratoma in an adolescent girl. Turk J Pediatr. 2017;59(1):90–2. Kusaka M, Mikuni M. Ectopic ovary: a case of autoamputated ovary with mature cystic teratoma into the cul-de-sac. J Obstet Gynaecol Res. 2007;33:368–7. Moawad NS, Starks D, Ashby K. Ectopic ovarian teratoma of the uterosacral ligament associated with a large ovarian dermoid. J Minim Invasive Gynecol. 2008;15:523–4. Daccache A, Feghali E, Assi R, Sleiman Z. Unplanned adnexectomy for ovarian cystadenoma with undiagnosed autoamputation of the contralateral ovary, lessons learned from medical mistakes. Facts Views Vis Obgyn. 2021;13(2):187–90. Nicola Zampieri 1, Scirè G, Zambon C, Ottolenghi A. Francesco Saverio Camoglio: Unusual presentation of antenatal ovarian torsion: free-floating abdominal cysts. Our experience and surgical management. J Laparoendosc Adv Surg Tech A. 2009 Apr;19(Suppl 1):S149–52. Vincent Durous L, Milot J-N, Buy B, Deval PR. Auto-amputated adnexa in a young woman: Multimodal imaging to rule in a pelvic rolling stone. J Gynecol Obstet Hum Reprod. 2019;48(6):423–6. Shahla Chaichian M, Khandan S, Rokhgireh S, Hosseini. Roya Derakhshan: A Case of Spontaneous Autoamputation of Ovary in a 46-Year-Old Woman: An Uncommon Presentation (Painless Ovarian Torsion) with Unique Diagnostic and Therapeutic Challenges. Case Rep Med. 2023 Dec;12:20232165226. Bozdag G, Demir B, Calis PT, Zengin D, Dilbaz B. The impact of adnexal torsion on antral follicle count when compared with contralateral ovary. J Minim Invasive Gynecol. 2014;21(4):632–5. Tsafrir Z, Hasson J, Levin I, Solomon E, Lessing JB, Azem F. Adnexal torsion: cystectomy and ovarian fixation are equally important in preventing recurrence. Eur J Obstet Gynecol Reprod Biol. 2012;162(2):203–5. Mansoureh Gorginzadeh B, Tajbakhsh S, Mortazi. Preservation of ovarian tissue embedded in omentum following torsion and auto-amputation of the left ovary and fallopian tube in a 14-year-old girl: A case report. Int J Surg Case Rep. 2023 Aug;109:108490. Santos XM, Cass DL, Dietrich JE. Outcome following detorsion of torsed adnexa in children. J Pediatr Adolesc Gynecol. 2015;28(3):136–8. Adnexal Torsion in Adolescents ACOG Committee Opinion No. Obstet Gynecol. 2019;134(2):e56–63. 783. Kim HG, Song YJ, Na YJ, Yang J. Choi O.H. A rare case of an autoamputated ovary with mature cystic teratoma. J Menopausal Med. 2017;23(1):74–6. Koga K, Hiroi H, Osuga Y, Nagai M, Yano T, Taketani Y. Autoamputated adnexa presents as a peritoneal loose body. Fertil Steril. 2010;93(3):967–8. Ayşe, Seyhan. İrem Usta Korkut, Bülent Urman: Autoamputation of the ovary after missed diagnosis of ovarian dermoid cyst torsion: a case report and review of literature. J Turk Ger Gynecol Assoc. 2025;26(4):304–8. John BM. Ectopic ovary with dermoid cyst as a result of possible asymptomatic autoamputation. J Hum Reprod Sci. 2017;10(3):226–30. Lili Ellison K, Sinclair Y, Sana. Recurrent ovarian and fallopian tube torsion: A case report. Case Rep Womens Health 2023 Dec 13:41e00575. Dubravko Habek I, Marton. Ana Tikvica Luetić, Matija Prka : Adnexal autoamputation after torsion. Arch Gynecol Obstet. 2022;305(5):1377. Erin M, Murphy N, Pereira AP, Melnick SD, Spandorfer. Spontaneous bilateral torsion of fallopian tubes presenting as primary infertility. Womens Health (Lond). 2016;12(3):297–301. Ferrera PC, Kass LE, Verdile VP. Torsion of the fallopian tube. Am J Emerg Med. 1995;13:312–4. Ghossain MA, Buy JN, Bazot M, Haddad S, Guinet C, Malbec L, et al. CT in adnexal torsion with emphasis on tubal findings: Correlation with US. J Comput Assist Tomogr. 1994;18:619–25. Ushakov FB, Meirow D, Prus D, Libson E, BenShushan A, Rojansky N. Parasitic ovarian dermoid tumor of the omentum—a review of the literature and report of two new cases. Eur J Obstet Gynecol Reprod Biol. 1998;81:77–82. 10.1016/S0301-2115(98)00144-4 . Ssi-Yan-Kai G, Rivain AL, Trichot C, et al. What every radiologist should know about adnexal torsion. Emerg Radiol. 2018;25(1):51–9. Valle Alonso J, Ruffino G, Hurdidge E. Abdominal pain in a young female adolescent: point-of-care ultrasound added value. Pediatr Emerg Care. 2020;36(7):355–7. Wattar B, Rimmer M, Rogozinska E, et al. Accuracy of imaging modalities for adnexal torsion: a systematic review and meta-analysis. BJOG. 2021;128(1):37–44. Tielli A, Scala A, Alison M, et al. Ovarian torsion: diagnosis, surgery, and fertility preservation in the pediatric population. Eur J Pediatr. 2022. 10.1007/s00431-021-04352-0 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 18 Mar, 2026 Reviews received at journal 18 Mar, 2026 Reviewers agreed at journal 18 Mar, 2026 Reviews received at journal 18 Mar, 2026 Reviewers agreed at journal 18 Mar, 2026 Reviews received at journal 18 Mar, 2026 Reviewers agreed at journal 18 Mar, 2026 Reviews received at journal 18 Mar, 2026 Reviewers agreed at journal 17 Mar, 2026 Reviewers agreed at journal 17 Mar, 2026 Reviewers agreed at journal 17 Mar, 2026 Reviews received at journal 12 Mar, 2026 Reviews received at journal 06 Mar, 2026 Reviewers agreed at journal 06 Mar, 2026 Reviewers agreed at journal 06 Mar, 2026 Reviews received at journal 04 Mar, 2026 Reviewers agreed at journal 04 Mar, 2026 Reviewers agreed at journal 02 Mar, 2026 Reviewers invited by journal 24 Feb, 2026 Editor invited by journal 03 Feb, 2026 Editor assigned by journal 29 Jan, 2026 Submission checks completed at journal 29 Jan, 2026 First submitted to journal 28 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8726570","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":596323695,"identity":"f4c316bc-15ee-4c7a-be2c-f0158c8f9c9a","order_by":0,"name":"Kino Hayashi","email":"","orcid":"","institution":"Sugita Genpaku Memorial Obama Municipal Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kino","middleName":"","lastName":"Hayashi","suffix":""},{"id":596323696,"identity":"d1b55bfb-3712-4d02-bfd6-ab3b961fed58","order_by":1,"name":"Hideaki Tsuyoshi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYFAC5gMGHxtsGBgkoHzGBoJa2BIKZzakkaSFx+Azb8NhhBaCQN69wXAD747zif2zmw8+YKixYWCeTcAawzMHkg0kz9xOnHHnWLIBw7E0BsY5BwhomZFwzMCw7XZiw40cMwlGoAsZZyQQ0pLY/iOx7VzifKK1yEskMxgcbDuQuIFoLQY8xxgMG9uSjTfeSEs2SDiWxkPQL/Lt/R+M/7bZyc67kXzwwYcaGzlDQiFmADXSEawO6CQewxn4dTDIQ420R4gQHaejYBSMglEwUgAAHgdLqhiaVmMAAAAASUVORK5CYII=","orcid":"","institution":"Faculty of Medical Sciences, University of Fukui","correspondingAuthor":true,"prefix":"","firstName":"Hideaki","middleName":"","lastName":"Tsuyoshi","suffix":""},{"id":596323697,"identity":"70c88dd8-b73e-4b49-8c67-62ddc22d1134","order_by":2,"name":"Akari Nakamori","email":"","orcid":"","institution":"Sugita Genpaku Memorial Obama Municipal Hospital","correspondingAuthor":false,"prefix":"","firstName":"Akari","middleName":"","lastName":"Nakamori","suffix":""},{"id":596323698,"identity":"da5c1351-845b-4456-a114-a09dbf0b396a","order_by":3,"name":"Michio Watanabe","email":"","orcid":"","institution":"Sugita Genpaku Memorial Obama Municipal Hospital","correspondingAuthor":false,"prefix":"","firstName":"Michio","middleName":"","lastName":"Watanabe","suffix":""},{"id":596323699,"identity":"3cf3bee6-3aa3-4e16-962b-c1f34f680a70","order_by":4,"name":"Yasuo Hayashi","email":"","orcid":"","institution":"Sugita Genpaku Memorial Obama Municipal Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yasuo","middleName":"","lastName":"Hayashi","suffix":""},{"id":596323700,"identity":"fdc2fe63-70e4-4ff3-9bf7-574be6b0eb37","order_by":5,"name":"Yuka Hattori","email":"","orcid":"","institution":"Sugita Genpaku Memorial Obama Municipal Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yuka","middleName":"","lastName":"Hattori","suffix":""},{"id":596323701,"identity":"cd779e45-45bb-49fe-ada4-99a17d91085a","order_by":6,"name":"Makoto Orisaka","email":"","orcid":"","institution":"Faculty of Medical Sciences, University of Fukui","correspondingAuthor":false,"prefix":"","firstName":"Makoto","middleName":"","lastName":"Orisaka","suffix":""},{"id":596323702,"identity":"44e6b5b4-072e-43e0-a9b1-47f70a72302e","order_by":7,"name":"Yoshio Yoshida","email":"","orcid":"","institution":"Faculty of Medical Sciences, University of Fukui","correspondingAuthor":false,"prefix":"","firstName":"Yoshio","middleName":"","lastName":"Yoshida","suffix":""}],"badges":[],"createdAt":"2026-01-29 03:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8726570/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8726570/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103590339,"identity":"3ad28b88-0089-4284-9d89-816c3dfa7083","added_by":"auto","created_at":"2026-02-27 12:02:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":210721,"visible":true,"origin":"","legend":"\u003cp\u003eAn axial T2-weighted MRI image revealed a multilocular tumor in the left ovary with a diameter of 65 mm. No solid components or wall thickening were present (arrow).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8726570/v1/c95246bcf6bbb67dbe44b2b4.png"},{"id":103590344,"identity":"88079d00-5711-4728-b310-50c3e7ce0131","added_by":"auto","created_at":"2026-02-27 12:02:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":201791,"visible":true,"origin":"","legend":"\u003cp\u003eA contrast-enhanced CT scan identified a 75 mm multilocular cystic lesion located in the left ovary within the left adnexal region, characterized by diminished contrast enhancement (arrow).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8726570/v1/06f22e042e40c3947bd200a9.png"},{"id":103590335,"identity":"dac381be-72fb-4c2c-8a3a-6056d5d6b630","added_by":"auto","created_at":"2026-02-27 12:02:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":211365,"visible":true,"origin":"","legend":"\u003cp\u003eContrast-enhanced CT revealed a whirlpool sign, indicative of torsion, in the left ovarian artery and vein (arrowhead).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8726570/v1/09e9fa07d28912cc5eaa6dbd.png"},{"id":103590333,"identity":"2978a5c7-773e-412c-ba66-2649ad7cf394","added_by":"auto","created_at":"2026-02-27 12:02:44","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":688292,"visible":true,"origin":"","legend":"\u003cp\u003eExamination of the abdominal cavity revealed that the left ovary was significantly lacerated, accompanied by hemorrhage (arrow).\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8726570/v1/e5a6bf4b17af490621f90312.png"},{"id":103590342,"identity":"2d983fcc-fc91-49a4-999b-bea79e157066","added_by":"auto","created_at":"2026-02-27 12:02:45","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":719828,"visible":true,"origin":"","legend":"\u003cp\u003eAssessment of the abdominal cavity indicated that the left fallopian tube, proper ovarian ligament, and infundibulopelvic ligament were congested and edematous (arrowhead). Additionally, a black mass approximately the size of a fist was identified in the pouch of Douglas (arrow).\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8726570/v1/d523dab56bc159e0bacaace4.png"},{"id":103590343,"identity":"c8c13a0b-323b-4baa-b71a-4e75c43b6880","added_by":"auto","created_at":"2026-02-27 12:02:45","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":603126,"visible":true,"origin":"","legend":"\u003cp\u003eIntra-abdominal findings indicated that the uterus, contralateral right ovary, and fallopian tube appeared normal.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-8726570/v1/aff288104a5b75ee621cacba.png"},{"id":103590340,"identity":"47b643ea-e014-4193-9561-68f06ccb5829","added_by":"auto","created_at":"2026-02-27 12:02:45","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":683475,"visible":true,"origin":"","legend":"\u003cp\u003eIntra-abdominal findings revealed that the mass in the pouch of Douglas showed no adhesions to the surrounding tissues or communication with other organs (arrow).\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-8726570/v1/617fbfcd3ee6651236370c04.png"},{"id":103590341,"identity":"c5ef2b59-573a-4c75-921c-adab31c8430f","added_by":"auto","created_at":"2026-02-27 12:02:45","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":537508,"visible":true,"origin":"","legend":"\u003cp\u003eGross examination of the excised mass in the pouch of Douglas showed a smooth cyst wall devoid of nodules or solid components.\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-8726570/v1/7c45bd8a58e3da7979a6650b.png"},{"id":103590336,"identity":"fea9abd0-d573-4a70-a3c3-b3c79bd9d323","added_by":"auto","created_at":"2026-02-27 12:02:44","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":989679,"visible":true,"origin":"","legend":"\u003cp\u003eHematoxylin-eosin staining of the pathological specimen revealed that the entire mass exhibited characteristics indicative of hemorrhagic infarction and necrosis due to edema. Ovarian stroma and follicles were also identified in certain regions (arrows) (magnification, × 100).\u003c/p\u003e","description":"","filename":"9.png","url":"https://assets-eu.researchsquare.com/files/rs-8726570/v1/15e21ce89690af388239c519.png"},{"id":103590338,"identity":"dcf2f373-febe-4948-aa57-32d2a4d2c511","added_by":"auto","created_at":"2026-02-27 12:02:44","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":334559,"visible":true,"origin":"","legend":"\u003cp\u003eTransvaginal ultrasound performed one month post-surgery revealed follicular development in the left ovary, which was the affected side (arrow).\u003c/p\u003e","description":"","filename":"10.png","url":"https://assets-eu.researchsquare.com/files/rs-8726570/v1/c2bcbdb6f1ac8e7d01f0ef26.png"},{"id":103590334,"identity":"15a2adbc-f71b-432c-be43-cc2d721db65d","added_by":"auto","created_at":"2026-02-27 12:02:44","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":69570,"visible":true,"origin":"","legend":"\u003cp\u003eThe schematic of a partial autoamputated ovary in the current shows that the affected normal ovary and fallopian tube remained with preserving the function although the ovarian tumor with pedicled torsion detached due to the necrosis. U, uterus; O, ovary; OT, ovarian tumor; FP, fallopian tube; OL, ovarian ligament; IL, infundibulopelvic ligament\u003c/p\u003e","description":"","filename":"11.png","url":"https://assets-eu.researchsquare.com/files/rs-8726570/v1/c16bd68bb5776fa8b6513fe7.png"},{"id":104398736,"identity":"03fe0136-b11c-44ac-aabc-f178da4430a7","added_by":"auto","created_at":"2026-03-11 12:03:31","extension":"png","order_by":12,"title":"Figure 12","display":"","copyAsset":false,"role":"figure","size":65955,"visible":true,"origin":"","legend":"\u003cp\u003eThe schematic of an autoamputated ovary in previous reports shows that affected whole ovary and fallopian tube detached with compromising the function. U, uterus; O, ovary; OT, ovarian tumor; FP, fallopian tube; OL, ovarian ligament; IL, infundibulopelvic ligament\u003c/p\u003e","description":"","filename":"12.png","url":"https://assets-eu.researchsquare.com/files/rs-8726570/v1/184c71ea768d0a6f315d3166.png"},{"id":104410160,"identity":"d090f1d1-b0dc-4c40-aa29-df8f3f68b8d2","added_by":"auto","created_at":"2026-03-11 12:49:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":8067061,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8726570/v1/361d2b61-33be-447d-a9cb-c3924de9b68d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Partial autoamputation of an ovary following adnexal torsion with preserved ovarian function in a reproductive-age woman: A case report and literature review","fulltext":[{"header":"Background","content":"\u003cp\u003eOvarian pedicle torsion is a well-recognized gynecological emergency, accounting for approximately 2.7% of all acute gynecologic conditions and ranking fifth in frequency among such emergencies (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Although it can occur across all age groups, it predominantly affects women of reproductive age, with nearly 30% of reported cases occurring in individuals younger than 20 years (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The condition arises when the adnexa twist around the axis formed by the ovarian and infundibulopelvic ligaments, leading to compromised vascular flow (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). While torsion may occur in morphologically normal ovaries, the risk is substantially increased in the presence of adnexal masses, particularly those exceeding 5 cm in diameter (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAn autoamputated ovary is a rare clinical entity, defined as the spontaneous detachment of a normal ovary or an ovarian tumor following prolonged pedicle torsion (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The reported incidence is extremely low, estimated at approximately 1 in 11,421 cases (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). It is postulated that sustained torsion results in ischemia and subsequent necrosis, ultimately leading to separation of the necrotic adnexal tissue due to complete disruption of the distal blood supply (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In most cases, the diagnosis is made intraoperatively upon the unexpected absence of an ovary, accompanied by a blindly ending fallopian tube lacking fimbriae or an identifiable infundibulum (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Preoperative diagnosis remains challenging, as no definitive imaging criteria have been established. Once autoamputation has occurred, therapeutic options are limited, and irreversible loss of ovarian function on the affected side is generally assumed, raising significant concerns regarding fertility preservation (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHerein, we report an exceptionally rare case in which ovarian pedicle torsion led to spontaneous detachment of an ovarian tumor with only partial autoamputation of the ovary. Remarkably, residual ovarian tissue with preserved function remained on the affected side, allowing for potential fertility preservation. To our knowledge, this is the first reported case of partial ovarian autoamputation in a reproductive-age woman with maintained ipsilateral ovarian function. This case provides novel insight into the pathophysiology of ovarian torsion and highlights the possibility of fertility preservation even after severe torsional events.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 29-year-old woman, gravida 1 para 0 (one prior induced abortion), presented with a regular menstrual cycle occurring every 30 days and lasting 4\u0026ndash;7 days. Her medical history included acute appendicitis at the age of 27, which was treated conservatively, and pelvic peritonitis secondary to Chlamydia trachomatis infection at the same age.\u003c/p\u003e \u003cp\u003eDuring a routine gynecological examination by her previous physician, a multilocular left ovarian tumor measuring 6.5 cm in diameter was detected. The patient requested surgical management and was referred to our department. Contrast-enhanced magnetic resonance imaging (MRI) demonstrated a 6.5 cm multilocular cystic mass in the left ovary, showing low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. No solid components or mural thickening suggestive of malignancy were identified, and the lesion was suspected to be a mucinous cystadenoma (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe patient had severe obesity (body mass index, 37 kg/m\u0026sup2;; height, 156 cm; weight, 90 kg) and poorly controlled type 2 diabetes mellitus (HbA1c, 9.2%). In consideration of the increased perioperative risk, surgical intervention was deferred, and medical optimization was prioritized.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe ovarian tumor was monitored at three-month intervals, during which no change in size was observed. Nine months after the initial consultation, the patient presented to the emergency department with persistent left lower abdominal pain that had begun the previous evening. She reported experiencing intermittent episodes of similar pain in the past, which had resolved spontaneously. Her last menstrual period had occurred 20 days prior and lasted four days, and her most recent sexual intercourse had been one week earlier.\u003c/p\u003e \u003cp\u003eAt presentation, torsion of the known left ovarian tumor was suspected, and she was referred to our department. Her vital signs were stable: heart rate 119 beats/min, blood pressure 110/80 mmHg, respiratory rate 16/min, body temperature 36.9\u0026deg;C, and oxygen saturation 98% on room air. On pelvic examination, marked tenderness was noted in the left lower abdomen, and a soft mass was palpated in the left adnexal region. Mild uterine tenderness and persistent reddish vaginal discharge were observed on speculum examination.\u003c/p\u003e \u003cp\u003eTransvaginal ultrasonography revealed no abnormalities in the endometrium or right adnexa, while a multilocular cyst measuring 7.5 \u0026times; 5.5 cm was identified in the left adnexal region. Laboratory tests showed mild inflammatory changes, with a white blood cell count of 11,260/\u0026micro;L and a C-reactive protein level of 3.496 mg/dL. Tumor markers CEA and CA19-9 were within normal limits (CEA\u0026thinsp;\u0026lt;\u0026thinsp;1.00 ng/mL; CA19-9, 3.4 U/mL), whereas CA125 was mildly elevated (54.3 U/mL). A pregnancy test was negative.\u003c/p\u003e \u003cp\u003eContrast-enhanced computed tomography (CT) demonstrated a 7.5-cm multilocular cystic mass in the left ovary with wall thickening and poor contrast enhancement (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). No mural nodules or solid components were identified, and there were no findings suggestive of malignancy. A whirlpool sign involving the left ovarian artery and vein was observed, consistent with adnexal torsion (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). No abnormalities were detected in other intra-abdominal organs.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eBased on these findings, emergency laparoscopic surgery was performed under general anesthesia. Intraoperatively, the left ovary was found to be severely lacerated and covered with blood (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The left fallopian tube, proper ovarian ligament, and infundibulopelvic ligament were markedly congested and edematous. A black, fist-sized mass was identified in the pouch of Douglas (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe uterus, right ovary, and right fallopian tube appeared normal (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e), and no ascites or additional intra-abdominal abnormalities were noted. The mass in the pouch of Douglas exhibited no adhesions to surrounding tissues and showed no communication with adjacent organs (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). After confirming hemostasis of the residual left ovary, the mass was excised, and the procedure was completed laparoscopically. The total operative time was 1 hour and 33 minutes, with an estimated blood loss of 100 mL.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eGross examination of the excised specimen revealed a cyst containing brown to reddish-brown serohemorrhagic fluid. The cyst wall was smooth, without nodules or solid components, and the boundary between the cyst wall and ovarian stroma was indistinct (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eHistopathological examination demonstrated widespread hemorrhagic infarction and edema, consistent with ischemic necrosis. Most of the cyst wall was necrotic, preventing evaluation of the epithelial lining. Focal neutrophilic infiltration suggested an acute inflammatory process, and marked fibrin deposition on the cyst surface indicated acute disruption of blood flow. Notably, ovarian stromal tissue containing follicles was identified in a localized area of the cyst wall (Fig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003e). Based on the pathological findings and clinical course, the mass in the pouch of Douglas was diagnosed as a necrotic ovarian tumor resulting from partial autoamputation secondary to torsion of the left ovarian tumor pedicle.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe postoperative course was uneventful, with no signs of infection. The patient was discharged on postoperative day 6. One month after surgery, transvaginal ultrasonography demonstrated follicular development in the affected ovary (Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003e), and normal menstruation resumed. At six months of follow-up, there was no evidence of tumor recurrence.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOvarian autoamputation represents a rare but clinically significant sequela of prolonged or repeated adnexal torsion. It is generally regarded as the terminal stage of ischemic injury, resulting in irreversible loss of ovarian and often tubal function on the affected side. The present case challenges this conventional understanding by demonstrating that partial autoamputation can occur with preservation of residual ovarian tissue and function, thereby expanding current knowledge regarding the pathophysiology and reproductive implications of adnexal torsion.\u003c/p\u003e \u003cp\u003ePreoperative diagnosis of adnexal torsion and subsequent autoamputation remains difficult because of nonspecific clinical symptoms and limitations of imaging modalities. Transvaginal ultrasonography is the first-line diagnostic tool for evaluating adnexal pathology and is frequently combined with laboratory testing and tumor marker assessment to exclude malignancy (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). However, preserved ovarian blood flow on Doppler imaging does not exclude torsion, as normal flow has been reported in up to 60% of torsion cases (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Contrast-enhanced computed tomography is often used in emergency settings but has lower sensitivity for torsion detection and involves radiation exposure (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMagnetic resonance imaging provides superior soft-tissue resolution and higher specificity for ovarian torsion, particularly in the presence of adnexal tumors (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Nonetheless, its limited availability in emergency situations restricts routine use (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Consequently, no imaging modality alone can reliably diagnose adnexal torsion or autoamputation, and clinical judgment remains essential (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Inflammatory markers such as leukocyte count and C-reactive protein may be elevated but lack diagnostic specificity (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the present case, serial imaging initially suggested a benign ovarian tumor, while emergency CT demonstrated indirect signs of torsion, including the whirlpool sign. Despite these findings, partial autoamputation could not be diagnosed preoperatively. This underscores the importance of maintaining a high index of suspicion and considering early surgical exploration when torsion is clinically suspected, regardless of equivocal imaging results. An autoamputation of the ovary is believed to result from sustained or intermittent torsion leading to ischemia, hemorrhagic infarction, and necrosis. In some cases, the necrotic ovary or tumor detaches completely and may subsequently reimplant on adjacent structures, such as the omentum or bowel, potentially developing collateral blood supply (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). However, the precise mechanisms underlying detachment and engraftment remain incompletely understood.\u003c/p\u003e \u003cp\u003eIn the present case, histopathological examination revealed widespread hemorrhagic infarction, fibrin deposition, and focal inflammatory infiltration, indicating acute ischemic necrosis. Importantly, ovarian stromal tissue containing follicles was identified in a localized area of the cyst wall, suggesting that ischemic damage was not uniform. We propose that torsion of the ovarian tumor pedicle led to necrosis and detachment of the tumor itself, while spontaneous detorsion occurred before irreversible ischemia developed in the remaining ovary and fallopian tube. Residual edema of the adnexal ligaments observed intraoperatively supports this hypothesis.\u003c/p\u003e \u003cp\u003eTo contextualize this case, we conducted a comprehensive review of published case reports of autoamputated ovaries in women of reproductive age between 2016 and 2025 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Fourteen cases were identified. Abdominal or pelvic pain was the most common presenting symptom, occurring in 50% of cases, whereas 36% were asymptomatic and diagnosed incidentally during unrelated surgical procedures. Less common presentations included secondary amenorrhea, vomiting, and inflammatory symptoms. Notably, in all reported cases, including the present one, the diagnosis of autoamputation was made intraoperatively, highlighting the absence of reliable preoperative diagnostic criteria.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLiterature review of autoamputated ovaries in women of reproductive age, published between 2016 and 2025.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSymptoms\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDiameter (mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePathology\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSide\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eOvary\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eFallopian tube\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eParasite\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003efunction of the affected adnexa\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMurphy(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eInfertility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eー\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHydrosalpinx\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eintact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003epartial amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKim(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003emass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJohn(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSterization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003epartial amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003epouch of Douglas, rectum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAtici(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAbd pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003epartial amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDurous(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLower back pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFibroma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDaccache(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003emass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHabek(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAbd pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003esimple cyst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAtileh(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAbd pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEndometrioma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003epartial amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGorginzadeh(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003emass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003ewithin the omentum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChaichain(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eamenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEllison (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAbd pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMariam S(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003emass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003esimple cyst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eintact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003epartial amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAyşe Seyhan(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAbd pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ecomplete amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003epouch of Douglas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eLost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOur case\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAbd pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003epartial amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eintact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePreservation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003eMCT, Mature cystic teratoma: MCA, Mucinous cystic adenoma\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePost-autoamputation implantation of ovarian tissue was reported in 21% of cases, most frequently in the pouch of Douglas, omentum, or sigmoid colon. Mature cystic teratoma was the most common pathological diagnosis, accounting for 50% of cases, followed by fibromas, simple cysts, endometriotic cysts, and torsion associated with hydrosalpinx. Tumor size ranged from 2 to 13 cm, with a slight predominance of left-sided involvement.\u003c/p\u003e \u003cp\u003eCrucially, in all reviewed cases except the present one, reproductive potential on the affected side was irreversibly compromised. The fallopian tube was either blind-ending due to loss of fimbriae or entirely absent, and in 71% of cases the ovary was completely missing. These findings support the prevailing view that autoamputation typically represents a catastrophic event for fertility. In contrast, our case uniquely demonstrated preservation of both ovarian tissue and tubal continuity, with postoperative follicular development confirming retained ovarian function.\u003c/p\u003e \u003cp\u003eAutoamputation of the ovary is believed to result from sustained or intermittent torsion leading to ischemia, hemorrhagic infarction, and necrosis (Fig.\u0026nbsp;\u003cspan refid=\"Fig11\" class=\"InternalRef\"\u003e11\u003c/span\u003e). In some cases, the necrotic ovary or tumor detaches completely and may subsequently reimplant on adjacent structures, such as the omentum or bowel, potentially developing collateral blood supply (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). However, the precise mechanisms underlying detachment and engraftment remain incompletely understood.\u003c/p\u003e \u003cp\u003eIn the present case, histopathological examination revealed widespread hemorrhagic infarction, fibrin deposition, and focal inflammatory infiltration, indicating acute ischemic necrosis. Importantly, ovarian stromal tissue containing follicles was identified in a localized area of the cyst wall, suggesting that ischemic damage was not uniform. We propose that torsion of the ovarian tumor pedicle led to necrosis and detachment of the tumor itself, while spontaneous detorsion occurred before irreversible ischemia developed in the remaining ovary and fallopian tube. Residual edema of the adnexal ligaments observed intraoperatively supports this hypothesis (Fig.\u0026nbsp;\u003cspan refid=\"Fig12\" class=\"InternalRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis report describes the first documented case of partial ovarian autoamputation secondary to torsion of an ovarian tumor pedicle with preservation of ipsilateral ovarian and tubal function. While ovarian autoamputation is generally associated with irreversible loss of fertility, this case demonstrates that spontaneous detachment of necrotic tissue does not inevitably result in complete loss of ovarian function. Clinicians should be aware of the diagnostic limitations of imaging and the potential for atypical clinical courses. In reproductive-age women, early surgical intervention remains critical to maximizing the possibility of fertility preservation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHbA1c, hemoglobin A1c; MRI, magnetic resonance imaging; CT, computed tomography; SpO2, saturation of percutaneous oxygen; WBC, white blood cell; CRP, C-reactive protein; CEA, carcinoembryonic antigen; CA19-9: carbohydrate antigen 19-9; CA125, cancer antigen 125\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis report was approved by the Hospital Ethics Committee of the University of Fukui.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn accordance with ethical guidelines, written informed consent for publication of this case report and accompanying images was obtained from the patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available within the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKH, AN, NW, and TH performed surgeries. KH, HT, AN, and YH were involved in data acquisition and preparation of the figures. KH and HT wrote the manuscript. MO and YY proofread and revised the manuscript. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAtileh LIA, Khalifeh NMD. Fallopian tube autoamputation after acute large endometrioma torsion. Gynecol Minim Invasive Ther. 2022;11(2):124\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSankaran S, Shahid A, Odejinmi F. Autoamputation of the fallopian tube after chronic adnexal torsion. J Minim Invasive Gynecol. 2009;16(2):219\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSasaki KJ, Miller CE. Adnexal torsion: review of the literature. J Minim Invasive Gynecol. 2014;21(2):196\u0026ndash;202.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAshwal E, Hiersch L, Krissi H, et al. Characteristics and management of ovarian torsion in premenarchal compared with postmenarchal patients. Obstet Gynecol. 2015;126(3):514\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhosh A, McKay R. A missed diagnosis of ovarian torsion in a patient with bilateral ovarian dermoid cysts: a case report. Cureus. 2019;11(10):5963.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee KH, Song MJ. In Cheul Jung, Yong Seok Lee \u0026amp; Eun Kyung Park, Autoamputation of an ovarian mature cystic teratoma: a case report and a review of the literature: World J Surg Oncol. :2016;14(1):217.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSivanesaratnam V. Unexplained unilateral absence of ovary and fallopian tube. Eur J Obstet Gynecol Reprod Biol. 1986;22:103\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMariam S, Banoub EM, Konrath BA, Khan, Rayan A, Elkattah. Spontaneous Autoamputation Adnexa CRSLS. 2024;11(3):e202400025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAtıcı A, Yılmaz E, Karaman A, Apaydın S, Afşarlar. \u0026Ccedil;.E. Tuba-ovarian auto-amputation caused by ovarian teratoma in an adolescent girl. Turk J Pediatr. 2017;59(1):90\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKusaka M, Mikuni M. Ectopic ovary: a case of autoamputated ovary with mature cystic teratoma into the cul-de-sac. J Obstet Gynaecol Res. 2007;33:368\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoawad NS, Starks D, Ashby K. Ectopic ovarian teratoma of the uterosacral ligament associated with a large ovarian dermoid. J Minim Invasive Gynecol. 2008;15:523\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDaccache A, Feghali E, Assi R, Sleiman Z. Unplanned adnexectomy for ovarian cystadenoma with undiagnosed autoamputation of the contralateral ovary, lessons learned from medical mistakes. Facts Views Vis Obgyn. 2021;13(2):187\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNicola Zampieri 1, Scir\u0026egrave; G, Zambon C, Ottolenghi A. Francesco Saverio Camoglio: Unusual presentation of antenatal ovarian torsion: free-floating abdominal cysts. Our experience and surgical management. J Laparoendosc Adv Surg Tech A. 2009 Apr;19(Suppl 1):S149\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVincent Durous L, Milot J-N, Buy B, Deval PR. Auto-amputated adnexa in a young woman: Multimodal imaging to rule in a pelvic rolling stone. J Gynecol Obstet Hum Reprod. 2019;48(6):423\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShahla Chaichian M, Khandan S, Rokhgireh S, Hosseini. Roya Derakhshan: A Case of Spontaneous Autoamputation of Ovary in a 46-Year-Old Woman: An Uncommon Presentation (Painless Ovarian Torsion) with Unique Diagnostic and Therapeutic Challenges. Case Rep Med. 2023 Dec;12:20232165226.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBozdag G, Demir B, Calis PT, Zengin D, Dilbaz B. The impact of adnexal torsion on antral follicle count when compared with contralateral ovary. J Minim Invasive Gynecol. 2014;21(4):632\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsafrir Z, Hasson J, Levin I, Solomon E, Lessing JB, Azem F. Adnexal torsion: cystectomy and ovarian fixation are equally important in preventing recurrence. Eur J Obstet Gynecol Reprod Biol. 2012;162(2):203\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMansoureh Gorginzadeh B, Tajbakhsh S, Mortazi. Preservation of ovarian tissue embedded in omentum following torsion and auto-amputation of the left ovary and fallopian tube in a 14-year-old girl: A case report. Int J Surg Case Rep. 2023 Aug;109:108490.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantos XM, Cass DL, Dietrich JE. Outcome following detorsion of torsed adnexa in children. J Pediatr Adolesc Gynecol. 2015;28(3):136\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdnexal Torsion in Adolescents ACOG Committee Opinion No. Obstet Gynecol. 2019;134(2):e56\u0026ndash;63. 783.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim HG, Song YJ, Na YJ, Yang J. Choi O.H. A rare case of an autoamputated ovary with mature cystic teratoma. J Menopausal Med. 2017;23(1):74\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoga K, Hiroi H, Osuga Y, Nagai M, Yano T, Taketani Y. Autoamputated adnexa presents as a peritoneal loose body. Fertil Steril. 2010;93(3):967\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyşe, Seyhan. İrem Usta Korkut, B\u0026uuml;lent Urman: Autoamputation of the ovary after missed diagnosis of ovarian dermoid cyst torsion: a case report and review of literature. J Turk Ger Gynecol Assoc. 2025;26(4):304\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohn BM. Ectopic ovary with dermoid cyst as a result of possible asymptomatic autoamputation. J Hum Reprod Sci. 2017;10(3):226\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLili Ellison K, Sinclair Y, Sana. Recurrent ovarian and fallopian tube torsion: A case report. Case Rep Womens Health 2023 Dec 13:41e00575.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDubravko Habek I, Marton. Ana Tikvica Luetić, Matija Prka : Adnexal autoamputation after torsion. Arch Gynecol Obstet. 2022;305(5):1377.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErin M, Murphy N, Pereira AP, Melnick SD, Spandorfer. Spontaneous bilateral torsion of fallopian tubes presenting as primary infertility. Womens Health (Lond). 2016;12(3):297\u0026ndash;301.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerrera PC, Kass LE, Verdile VP. Torsion of the fallopian tube. Am J Emerg Med. 1995;13:312\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhossain MA, Buy JN, Bazot M, Haddad S, Guinet C, Malbec L, et al. CT in adnexal torsion with emphasis on tubal findings: Correlation with US. J Comput Assist Tomogr. 1994;18:619\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUshakov FB, Meirow D, Prus D, Libson E, BenShushan A, Rojansky N. Parasitic ovarian dermoid tumor of the omentum\u0026mdash;a review of the literature and report of two new cases. Eur J Obstet Gynecol Reprod Biol. 1998;81:77\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0301-2115(98)00144-4\u003c/span\u003e\u003cspan address=\"10.1016/S0301-2115(98)00144-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSsi-Yan-Kai G, Rivain AL, Trichot C, et al. What every radiologist should know about adnexal torsion. Emerg Radiol. 2018;25(1):51\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eValle Alonso J, Ruffino G, Hurdidge E. Abdominal pain in a young female adolescent: point-of-care ultrasound added value. Pediatr Emerg Care. 2020;36(7):355\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWattar B, Rimmer M, Rogozinska E, et al. Accuracy of imaging modalities for adnexal torsion: a systematic review and meta-analysis. BJOG. 2021;128(1):37\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTielli A, Scala A, Alison M, et al. Ovarian torsion: diagnosis, surgery, and fertility preservation in the pediatric population. Eur J Pediatr. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00431-021-04352-0\u003c/span\u003e\u003cspan address=\"10.1007/s00431-021-04352-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"ovarian tumor pedicle torsion, autoamputated ovary, laparoscopic surgery, preserved ovary, follicular development","lastPublishedDoi":"10.21203/rs.3.rs-8726570/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8726570/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOvarian autoamputation is a rare consequence of prolonged adnexal torsion and is generally associated with irreversible loss of ovarian and tubal function on the affected side. Preoperative diagnosis is challenging, and fertility preservation is rarely achievable once autoamputation has occurred. To date, no cases with preserved ipsilateral ovarian function after autoamputation have been reported.\u003c/p\u003e\u003ch2\u003eCase:\u003c/h2\u003e \u003cp\u003eA 29-year-old woman with a known benign-appearing left ovarian tumor presented with acute lower abdominal pain. Imaging studies suggested torsion of the ovarian tumor pedicle, and emergency laparoscopic surgery was performed. Intraoperatively, a necrotic, fist-sized mass consistent with an autoamputated ovarian tumor was identified in the pouch of Douglas, while the remaining ovary and fallopian tube were preserved. Histopathological examination revealed hemorrhagic infarction and necrosis of the tumor, with residual ovarian stroma containing follicles. Postoperative follow-up demonstrated normal follicular development and resumption of regular menstruation, confirming preserved ovarian function on the affected side.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis report describes the first documented case of partial ovarian autoamputation secondary to adnexal torsion with preservation of ipsilateral ovarian function. The findings suggest that spontaneous detachment of necrotic tissue does not inevitably result in complete loss of ovarian function. In reproductive-age women, early surgical intervention should be strongly considered when adnexal torsion is suspected, even in the absence of definitive imaging findings, to maximize the potential for fertility preservation.\u003c/p\u003e","manuscriptTitle":"Partial autoamputation of an ovary following adnexal torsion with preserved ovarian function in a reproductive-age woman: A case report and literature review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-27 12:02:39","doi":"10.21203/rs.3.rs-8726570/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-18T23:46:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T18:21:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"20798065359815399165864358833579932110","date":"2026-03-18T18:21:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T17:32:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"159453094304281748907209384866419777425","date":"2026-03-18T17:29:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T15:28:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50567426082882119895057286893896277295","date":"2026-03-18T14:22:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T11:10:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191231860093561366454846569129313746387","date":"2026-03-17T23:22:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"243638277470988914802203750054068979720","date":"2026-03-17T22:36:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"328405385085966153053280012999387176425","date":"2026-03-17T22:16:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-12T13:21:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-06T09:11:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"15018410589371114789036566490965773205","date":"2026-03-06T08:01:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"35213065630967045517345854449136513947","date":"2026-03-06T05:57:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-04T17:45:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"95550991394957873920992753530638335526","date":"2026-03-04T13:52:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"264463783840486572949965693361392065062","date":"2026-03-02T15:19:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-24T12:33:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-03T05:59:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-29T08:11:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-29T08:10:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2026-01-29T03:20:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2cc85d9f-c4b8-4762-899b-fcf02bf522c0","owner":[],"postedDate":"February 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-17T23:38:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-27 12:02:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8726570","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8726570","identity":"rs-8726570","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}