Ovarian torsion is a serious medical condition that occurs when an ovary twists around the around its axis, compromising blood flow. This can lead to reduced venous return, stromal edema, internal hemorrhage, and infarction, along with subsequent complications. Follicular torsion occurs when only a group of ovarian follicles rotate around its own axis. The torsion can be complete (360°) or partial (1–3).

Ovarian torsion in reptiles is rarely reported in the literature (1–5). To date, there are no reports in the order Chelonia. Sporadic cases have been reported in two species of iguana (Iguana iguana and Cyclura cornuta) (2), in a panther chameleon (Furcifer pardalis) (3), and in an Moroccan eyed lizard (Timon tangitanus) (1). Only one case of follicular torsion has been reported in literature, involving an iguana (Iguana iguana) (4). The clinical presentation was defined by non-specific symptoms, like anorexia, lethargy, and signs of pain-related behavior. In two cases surgery was performed and the animal recovered quickly (2, 3). Otherwise, the diagnosis was made postmortem. In iguanas, comorbidities affecting the reproductive system, such as bacterial oophoritis and egg retention, have been documented (2).

In a recently published paper, five cases of ovarian torsion were diagnosed in five geckos. All animals underwent to a bilateral ovariosalpingectomy. Surgery was resolutive in all but one gecko, that died few hours post operatively (5).

To date, in birds, only two reports of follicular torsion were published: the first case involves a young ostrich and the second in an older penguin. In both cases, the animals exhibited acute or hyperacute symptoms, dying, respectively, after 3 days and 1 day from the onset of symptoms. Both animals showed signs consistent with acute abdominal pain, anorexia, and significant depression. In both cases, the diagnosis was made post-mortem (6, 7).

In mammals, only case reports of ovarian torsions are currently documented. Three of these are associated with comorbidities or paraphysiological conditions of the reproductive system (pyometra, pregnancy, suspected neoplasia), and one is reported in a foal.

One case involved a 2-year-old female Golden Retriever with a pyometradiagnosis. A complete torsion of the left ovary was found duringovariohysterectomy (8).

In another report, a 8-month-old, female Husky developed ovarian torsion due to the torsion of the gravid uterine horn and uterine rupture (9). In a rabbit, the torsion was diagnosed during a routine check-up as the animal was completely asymptomatic. The causes of the torsion were not completely clarified, but a previous ovarian neoplasm is suspected, which may have led to the enlargement of the ovary and the subsequent torsion (10).

A 720-degree torsion of the left mesovarium was found in a 1-week-old foal that presented with acute abdominal pain. The affected ovary was surgically removed, and the foal fully recovered, showing no complications 2 years after the surgery (11).

In all these cases, the condition was treated surgically. Only in the case of the rabbit was the animal asymptomatic, while the other animals exhibited symptoms consistent with an acute abdomen.

In human medicine, ovarian torsion accounts for approximately 2–3% of gynecological emergencies (12). It is reported across all age groups, from pediatric patients to menopausal patients, but it is more common in patients of reproductive age (13). Torsion is reported to be associated with ovarian cysts or masses, typically larger than 5 cm in diameter. However, it can also occur in healthy ovaries, especially in prepubescent girls due to the presence of more elastic and elongated infundibulopelvic ligaments (12). Early diagnosis is crucial and often relies on transvaginal ultrasound and computed tomography (CT) scans (14). The primary treatment is emergency surgery to untwist the ovary and restore blood flow, with the goal of preserving the organ. This approach is particularly recommended for prepubescent patients, and oophoropexy is performed to prevent recurrence. Several studies show that timely intervention significantly increases the chances of preserving ovarian function into adulthood. If not treated promptly, ovarian torsion can lead to ovarian necrosis, resulting in the loss of the ovary and potential future fertility complications (12). The situation is different when a neoplastic process is suspected as the cause of the torsion; in this case, unilateral ovariectomy is indicated.

Reproductive disorders are frequently observed in captive reptiles (18). The most frequent conditions include infertility or failure to conceive, ovarian stasis, and egg retention (dystocia) (18). The causes of reproductive disorders in female chelonians in captivity are complex, multifactorial, and not yet fully understood (19). However, many authors suggest that poor management during the breeding season plays a significant role. Factors such as incorrect male-to-female ratios, improper or lack of male introduction, inadequate housing, absence of appropriate substrate for egg-laying, incorrect temperature and humidity ranges, and insufficient calcium supplementation and nutrition are commonly cited as contributors to the development of these disorders (19). In addition to environmental and management factors, the pathogenesis of these reproductive disorders is often influenced by concurrent medical conditions (19). Furthermore, pathological conditions directly involving the reproductive are also critical contributors to the development of these disorders (19).

In chelonians, reproductive disorders typically do not present with hyperacute clinical signs. More commonly, affected animals are brought in for evaluation due to a recent onset of dysorexia or anorexia, often occurring within the past week, along with signs of lethargy (18). These nonspecific symptoms, can be misinterpreted as normal by the owner during physiological conditions such as the oviposition period. To date, only one case of follicular torsion has been reported in reptiles, specifically in an iguana (4). All other case reports in reptiles, birds, and mammals refer to ovarian torsions. It is possible that the anatomy of the reptilian ovary, characterized by the presence of numerous follicles of varying sizes, could predispose them to developing follicular torsions as well. However, pathogenesis leading to a follicular torsion rather than an ovarian torsion remains unclear based solely on the single case available in the literature. In reports concerning ovarian torsion in lizards, the presence of painful symptoms was described (1–3); however, these signs are not easily recognized in chelonians.

The mild heterophilia noted in the complete blood count (CBC) is regarded as a nonspecific finding. In reptiles, heterophilia is commonly linked to inflammatory processes, which can arise from infectious diseases (such as bacterial and parasitic infections), tissue damage, and necrosis (16). The radiographic evaluation did not identify any abnormalities that could inform a diagnostic suspicion; however, ultrasound revealed alterations consistent with preovulatory follicular stasis. The lack of blood flow observed during the Color Flow examination could not rule out the possibility of a suspected follicular torsion affecting a cluster of follicles, although this could not be definitively assessed using this method. Considering the presence of this diagnostic suspicion, a contrast-enhanced CT scan was conducted. Unfortunately, the leakage of the contrast medium and the impossibility to obtain another venous access, failed to confirm the diagnosis via this imaging modality. In human medicine, a definitive gold standard for diagnosis remains elusive, with imaging techniques serving a critical role in generating diagnostic suspicion (13). The primary modalities utilized include ultrasound with Doppler assessment, followed by Magnetic Resonance Imaging (MRI), which is less accessible in veterinary practice. CT is used infrequently due to concerns regarding radiation exposure and the superior sensitivity of MRI in evaluating soft tissue structures (12). Ultimately, a definitive diagnosis is often achieved through the visualization of the twisted ovary during laparotomy (12).

In human medicine, where ovarian torsion typically presents with acute symptoms, surgical intervention is often performed promptly. The gold standard in such cases is to preserve the affected ovary by simply detorsing it. This technique boasts a high success rate, and most patients retain ovarian function following torsion (13). However, in instances where ovarian pathologies, such as tumors, are present, a unilateral oophorectomy is indicated. In the limited case reports involving avian and reptilian species, surgical intervention was performed in only a few instances, resulting in bilateral ovariosalpingectomy. In the present case, given the chronic nature of the torsion, the presence of preovulatory stasis and the owner’s lack of interest in maintaining the animal’s fertility, a bilateral ovariosalpingectomy was elected. A different approach may have been considered in other chelonian species of greater economic and conservation significance.

In human medicine, studies have shown that over 80% of patients undergoing surgery for ovarian torsion present with a mass at the ovarian level, typically an ovarian cyst or neoplasm, with a diameter greater than 5 cm (13). This finding is often correlated with the primary cause of ovarian torsion in humans. In contrast, the underlying causes of ovarian torsion in reptiles and avian species are not consistently identified. Some cases have reported the presence of concurrent infections affecting either the reproductive system or other organs, as well as signs of preovulatory follicular stasis in both ovaries (1–3). However, it remains unclear whether these factors directly contribute to ovarian torsion, as similar alterations have not been observed in all affected individuals. In our case, a concurrent bacterial coelomitis accompanied by preovulatory follicular stasis was noted. It is hypothesized that the presence of multiple large follicles may have induced a “mass effect,” mechanically leading to the torsion, as reported in human cases.

Reptile medicine is constantly evolving, and it is crucial when working with these animals not to exclude unreported pathologies and to use advanced diagnostic tools to investigate issues thoroughly. In reptiles, cases of suspected preovulatory follicular stasis should not be limited to preliminary diagnosis or ultrasound examination. The use of diagnostic tools like Color Flow, or more advanced techniques like CT or MRI can aid in adding ovarian torsion to the differential diagnosis list.