BACKGROUND: Ovarian torsion is a gynecological emergency typically presenting with acute abdominal pain, but chronic torsion may manifest as nonspecific chronic pain, posing diagnostic challenges.

CASE REPORT: We report a 36-year-old woman with conversion disorder and a decade-long history of recurrent left lower abdominal pain, backache, and thigh paresthesia. Initial imaging was unremarkable, but during an acute episode, magnetic resonance imaging revealed acute-on-chronic left ovarian torsion with pelvic congestion. Despite intraoperative findings of a viable but congested ovary and elongated fallopian tube, a left oophorectomy was performed due to recurrent torsion and irreversible vascular compromise. Postoperatively, her pain resolved completely.

CONCLUSIONS: Our case highlights the importance of considering ovarian torsion in chronic pain syndromes and discusses the balance between ovarian preservation and definitive management in recurrent cases. While ovarian preservation is prioritized, shared decision-making is essential in recurrent cases.

KEYWORDS: Low backache, chronic pain, meralgia paresthetica, ovarian torsion