Background: Ovarian torsion is a rare gynaecological emergency in adolescent population with the incidence ranges from 2/10,000 to 4.9/100,000. It often requires immediate surgical intervention with the aim to salvage the affected ovary. If the ovary is clinically deemed non-viable with gangrenous macroscopic appearance, oophorectomy is performed traditionally. Currently, a newer conservative method of detorsion and conservation of the twisted ovarian cyst has emerged as it is proven that seemingly gangrenous ovarian tissue is still capable of remaining viable even after prolonged ischemia. The theoretically risk of untwisting a gangrenous ovarian cyst is pulmonary embolism but has been shown to be unlikely.

Case: We reported two cases of young adolescents presented with acute abdomen secondary to ovarian cyst torsion and both were successfully managed with a two-stage conservative laparoscopic surgery (laparoscopic detorsion followed by interval cystectomy). Although the twisted ovary appeared gangrenous during emergency diagnostic laparoscopy in both cases, detorsion rather than conventional oophorectomy was performed. Subsequent second-look laparoscopy revealed viable ovary which led to only performing a cystectomy and thus salvaging a previously apparent gangrened ovary. Histopathological examination confirmed benign ovarian cyst for both cases.

Conclusion: Laparoscopic detorsion is currently the preferred choice of treatment for twisted ovary in adolescents, despite its gangrenous appearance. This would be a superior option to maximise female ovarian reserve and future reproductive potential.