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Acute abdominal pain during pregnancy is encountered frequently and the differential diagnosis is extensive. Acute ovarian torsion in a pregnant patient is rare and is difficult to diagnose. Infarction caused by ovarian torsion will result if the twist is not unwound spontaneously or surgically in a timely fashion. The case is described of a 28-year-old primigravida who originally presented to the emergency department with right lower abdominal pain. The patient was ultimately found to have an extremely large cystic teratoma of the right ovary with concomitant torsion. Bedside ultrasonography is a highly accessible tool that can be used in a pregnant woman for screening a mass or ascites. Laparoscopic surgery has now been accepted as a safe modality for definitive diagnosis and therapeutic intervention. Because acute ovarian torsion is not encountered frequently, timely diagnosis is required to prevent mortality and minimise morbidity. It is important to keep ovarian torsion in the differential diagnosis of any pregnant woman with acute abdominal pain. Emergency physicians should be aware of the possibility of acute ovarian torsion in pregnant women and should have a high index of suspicion. Early surgical intervention should be undertaken.

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