A case of recurrent massive ovarian edema manifesting as acute abdomen first operated via laparoscopic surgery

We report a case of recurrent massive ovarian edema (MOE) manifesting as acute abdomen. At the first onset, we presumed MOE with torsion because of the immense pain in the patient's right adnexa. We considered that the torsion was spontaneously released at the time of laparoscopic surgery. During the conservative follow-up, the right ovary returned to its normal size, and the pain disappeared. After 3 years, MOE recurred and manifested as acute abdomen. The corresponding pain was relieved, and the ovarian volume was reduced by the prescribed analgesics. The magnetic resonance images of the first and second MOE were similar, so we retrospectively considered that the ovary was not twisted in both instances. In about half of the MOE cases, the ovary does not twist. The assumption that MOE occurs on the basis of lymphatic or vascular circulatory disorders of the ovary supports that MOE should manifest as acute abdomen even in the absence of adnexal torsion. Patients experiencing ovarian torsion should be surgically treated promptly to preserve their ovarian function. However, they can avoid unnecessary surgical intervention if we consider that the ovaries in some MOE cases with severe abdominal pain do not twist and that their symptoms disappear spontaneously.