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Mature cystic teratoma (MCT) is a common benign ovarian neoplasm, but its presentation as bilateral, giant masses in a prepubertal child is rare. Complications like torsion and acute urinary retention pose significant diagnostic and management challenges, where fertility preservation is a primary concern. An 8-year-old premenarchal girl presented with a four-day history of abdominal pain, fever, and acute urinary retention. Examination revealed a large, firm abdominal mass. Imaging suggested bilateral immature teratoma. Emergency laparotomy revealed two massive ovarian masses, with the left torsed, ischemic, and a rudimentary uterus. Bilateral ovarian cystectomy was successfully performed. Histopathology confirmed a right-sided mature cystic teratoma and left-sided hemorrhagic necrosis from torsion, ruling out malignancy. The patient had an uneventful recovery and was commenced on hormone replacement therapy due to compromised ovarian reserve. At two-year follow-up, she remains stable with no complaints. This case underscores that giant ovarian teratomas, though rare in children, can present dramatically. It highlights the critical importance of a fertility-preserving surgical approach even in complex cases and the necessity of long-term, multidisciplinary follow-up to manage subsequent endocrine sequelae.