A rare case of ovarian torsion in a pregnant patient

Torsion of the ovary is the total or partial rotation of the adnexa around its vascular axis or pedicle. It is an uncommon cause of acute abdominal pain in females, and it is a gynecologic emergency. The majority of the cases present in the pregnant (22.7%) than in non-pregnant (6.1%) women. Diagnostic delay can result in loss of the ovary. This twisting initially obstructs venous flow, which causes engorgement and edema. The engorgement can progress until arterial flow is also compromised, leading to ischemia and infarction. The increased use of ovarian stimulation and assisted reproductive technology has led to an increase in the risk of adnexal torsion, particularly in pregnant women or women with ovarian hyperstimulation syndrome (OHSS). The differential diagnosis of adnexal torsion is particularly difficult in combination with OHSS or pregnancy, as abdominal pain, nausea and vomiting can be presenting symptoms of hyperstimulation or pregnancy as well. Here, we report a case of ovarian torsion occurring in pregnancy in which diagnostic delay occurred due to confusion with OHSS leading to oophorectomy. Fertility conservation may have been possible in case of earlier diagnosis and prompt treatment.

Download Full-text

Torsion of the Ovary in Infancy, a Rare Emergency; A Case Report

Asian Journal of Medicine and Health ◽

10.9734/ajmah/2021/v19i930370 ◽

2021 ◽

pp. 90-96

Author(s):

Abdelilah Radi ◽

Karima Larbi Ouassou ◽

Amal Hassani ◽

Rachid Abilkassem ◽

Aomar Agadr ◽

...

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Clinical Evaluation ◽

Clinical Picture ◽

Acute Abdominal Pain ◽

Rare Condition ◽

Ovarian Torsion ◽

Positive Diagnosis ◽

Hemorrhagic Risk ◽

Made In

Torsion of the ovary is a rare condition whose diagnosis remains difficult given the non-specificity of the clinical picture as well as the difficulty of clinical evaluation, especially in young girls. It is a surgical emergency because it involves the vital prognosis by the hemorrhagic risk, and functional prognosis by the risk of infertility. The clinical picture is dominated by acute abdominal pain. Our work reports the case of a 2-year-old girl in whom the diagnosis of ovarian torsion was made in front of an atypical clinical picture. Laparoscopy is the method of choice for making a positive diagnosis and performing a conservative procedure as described in this work.

Download Full-text

Prediction of Adnexal Torsion by Ultrasound in Women with Acute Abdominal Pain

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1014-2593 ◽

2019 ◽

Vol 41 (06) ◽

pp. 688-694

Author(s):

Ron Bardin ◽

Noga Perl ◽

Reuven Mashiach ◽

Eitan Ram ◽

Sharon Orbach-Zinger ◽

...

Keyword(s):

Abdominal Pain ◽

Positive Predictive Value ◽

Predictive Value ◽

False Positive ◽

Acute Abdominal Pain ◽

Cohort Analysis ◽

False Negative ◽

True Positive ◽

Adnexal Torsion ◽

Positive Group

Abstract Purpose To investigate the accuracy of ultrasound in the diagnosis of adnexal torsion. Materials and Methods Retrospective cohort analysis of 322 women, presenting to a tertiary medical center with acute abdominal pain, who underwent gynecological examination, sonographic evaluation and laparoscopic surgery, between 2010 and 2016. Findings for adnexal torsion were compared among three groups: positive sonographic findings consistent with surgically confirmed adnexal torsion (true positive, n = 228); negative sonographic findings inconsistent with surgically confirmed adnexal torsion (false negative, n = 42); and positive sonographic findings inconsistent with a surgical diagnosis other than adnexal torsion (false positive, n = 52). Outcome measures were sensitivity and positive predictive value of ultrasound, and its specific features, for the diagnosis of adnexal torsion. Results The sensitivity of ultrasound for adnexal torsion diagnosis was 84.4 %, and the positive predictive value was 81.4 %. Edematous ovary and/or tube, as well as positive whirlpool sign had the highest sensitivity and positive predictive value. The false-negative group had the highest frequency of ovarian cysts (p = 0.0086) and the lowest frequency of ovarian edema (p < 0.0001). The false-positive group had the lowest proportion of pregnant women (p = 0.0022). Significantly more women in the true-positive group had a prior event of adnexal torsion (p = 0.026). Conclusion Ultrasound examination is highly accurate in the diagnosis of adnexal torsion. Clinicians should be aware of the presence of demographic and clinical characteristics that may positively or negatively affect sonographic diagnostic accuracy.

Download Full-text

Use of Computerized Tomography in Abdominal Pain

The American Surgeon ◽

10.1177/000313481808400671 ◽

2018 ◽

Vol 84 (6) ◽

pp. 1091-1096 ◽

Cited By ~ 1

Author(s):

Astha Bhatt ◽

Xihua Yang ◽

Nihaal Karnik ◽

Anne Sill ◽

Gopal Kowdley

Keyword(s):

Abdominal Pain ◽

Incidental Findings ◽

Acute Abdominal Pain ◽

Imaging Modality ◽

Fold Increase ◽

The United States ◽

Presenting Symptoms ◽

Left Flank Pain ◽

Level Of Agreement

Annually, approximately 70 million computed tomography (CT) scans are performed in emergency department (ED) settings in the United States of America. From 1995 to 2007, there has been a 5.9-fold increase in the use of CTscans nationally. The radiation risks and high costs associated with CTscans underscore the fact that the imaging modality, although necessary, carries a myriad of long-term risks to both patients and providers. For the workup of abdominal pain, most algorithms include the use of CTscan as an early step. To understand better the use of CTscans in our ED, we performed a retrospective review of patients presenting to the ED with abdominal pain. Two main questions were addressed: 1) what were the reasons for scans and how often did the scans reveal pathology related to the presenting symptoms, 2) how often were incidental findings identified. Our results showed that among patients presenting with abdominal pain to the ED, 50 per cent of the scans were normal, about 20 per cent of the patients had findings correlating with acute abdominal pain, whereas the rest (30%) had incidental findings that may have led to further outpatient studies or long standing abdominal pain. Most patients who presented to the ED had nonspecific abdominal pain i.e. 64.4 per cent. There was a low agreement between the presenting quadrant of pain and final pathological diagnosis (9.5–33.3% concordance), with left flank pain presentation having the highest level of agreement with the final pathologic diagnosis.

Download Full-text

Pregnant patient with acute abdominal pain and previous bariatric surgery

BMJ Case Reports ◽

10.1136/bcr-2018-228962 ◽

2019 ◽

Vol 12 (8) ◽

pp. e228962 ◽

Cited By ~ 4

Author(s):

Wouter KG Leclercq ◽

Martine Uittenbogaart ◽

Hendrik J Niemarkt ◽

Judith OEH van Laar

Keyword(s):

Bariatric Surgery ◽

Abdominal Pain ◽

Gestational Age ◽

Acute Abdominal Pain ◽

Gastric Bypass Surgery ◽

Pregnant Patient ◽

Internal Herniation ◽

Diffuse Abdominal Pain ◽

Imaging Patient

Pregnant women who previously had bariatric surgery may develop acute abdominal pain during pregnancy. Two patients, 38-year-old twin primigravida (gestational age of 24+6 weeks) and a 26-year-old woman (gestational age of 24+0 weeks), both of whom had laparoscopic gastric bypass surgery previously, developed abdominal pain. The patients both had diffuse abdominal pain in combination with normal blood tests and imaging. Patient B had undergone laparoscopy at another centre after 5 weeks of gestation for internal herniation. After referral to our multidisciplinary bariatric–obstetric–neonatal (MD-BON) team, diagnostic laparoscopy was advised as internal herniation was deemed possible. In both patients, internal herniation was indeed found in Petersen’s space and jejunal mesenteric defect, which was closed using laparoscopic surgery. Both women delivered healthy offspring afterwards. The presence of an MD-BON team allows for an increased awareness of potential long-term complications associated with earlier bariatric surgery in pregnancy.

Download Full-text

Surgical tactic in treatment of ovarian masses in adolescents

Pediatrician (St Petersburg) ◽

10.17816/ped6181-86 ◽

2015 ◽

Vol 6 (1) ◽

pp. 81-86

Author(s):

Svetlana Alekseevna Leontyeva ◽

Elena Aleksandrovna Ulrikh ◽

Nadezda Anatolyevna Kokhreidze

Keyword(s):

Abdominal Pain ◽

Surgical Treatment ◽

Ovarian Tumor ◽

Acute Abdominal Pain ◽

Malignant Tumors ◽

Ovarian Torsion ◽

Reproductive Status ◽

Gonadotropin Stimulation ◽

Ovarian Masses ◽

Status Of Women

Ovarian lesions in children are most frequently diagnosed in pubertal period. That could be associated with increased gonadotropin stimulation in this period. Most of the andexal masses in adolescents are benign. Malignant tumors of the ovary account less than 2 % in girls. Every girl with ovarian tumor and acute abdominal pain requires urgent differential diagnostic intervention and/or surgical treatment. The proportion of ovarian torsion is 2-3 % of all cases of abdominal pain in girls. This condition is an emergent gynecological pathology. One of the main aim of surgical treatment in young is to preserve fertility. Different surgery tactics in cases of ovarian masses in adolescents are reviewed in the article. The reproductive status of women underwent treatment for ovarian masses in childhood requires further investigations.

Download Full-text

Paediatric ovarian torsion: a case report and review of literature

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20202366 ◽

2020 ◽

Vol 9 (6) ◽

pp. 2638

Author(s):

Umang . ◽

Harleen Kaur Cheema ◽

Sidharth Khullar ◽

Madhu Nagpal

Keyword(s):

Abdominal Pain ◽

Acute Abdominal Pain ◽

Rare Condition ◽

Signs And Symptoms ◽

Conservative Surgery ◽

Ovarian Torsion ◽

High Clinical Suspicion ◽

Abdominal And Pelvic Pain ◽

Intra Abdominal Infection ◽

Prompt Diagnosis

Ovarian torsion is a surgical emergency, can result in ovarian loss, intra-abdominal infection and even death. Paediatric ovarian torsion is a rare condition, requires high clinical suspicion and prompt diagnosis. Diagnosis is a challenge since signs and symptoms are similar to those of other causes of acute abdominal pain such as appendicitis, gastroenteritis, urinary tract infection, renal colic or other conditions of acute abdominal and pelvic pain. Here, authors describe a case of a 4-year-old girl with a presentation of acute abdominal pain, treated empirically elsewhere. After investigations, a provisional diagnosis of ovarian torsion was made and patient was taken up for surgery. Intraoperatively, ovary was found to be necrosed. Detorsion was tried but ovary was unsalvageable. Right sided salpingectomy with oophorectomy was performed. Conservative surgery by laparoscopic detorsion can be tried in cases of ischemia but if necrosis has already set in, then salpingo-oophorectomy has to be performed.

Download Full-text

Radiology in the Pregnant Patient with Acute Abdominal Pain

Multidisciplinary Approaches to Common Surgical Problems ◽

10.1007/978-3-030-12823-4_37 ◽

2019 ◽

pp. 371-378

Author(s):

Mustafa M. Alikhan

Keyword(s):

Abdominal Pain ◽

Acute Abdominal Pain ◽

Pregnant Patient

Download Full-text

Laparoscopic Adnexal Detorsion in a 20-Week Pregnant Patient: A Case Report and Literature Review

Case Reports in Obstetrics and Gynecology ◽

10.1155/2019/1093626 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Rawad Halimeh ◽

Serge Tomassian ◽

Maria El Hage ◽

Nicole Metri ◽

Marianne Bersaoui ◽

...

Keyword(s):

Laparoscopic Approach ◽

Pregnant Patient ◽

Ovarian Torsion ◽

Neonatal Outcomes ◽

Adnexal Torsion ◽

Risks And Benefits ◽

Surgical Options ◽

Maternal And Neonatal Outcomes ◽

Reproductive Aged Women ◽

Prompt Diagnosis

Adnexal torsion is a cause of severe pelvic pain in reproductive aged women and during pregnancy. Adnexal torsion occurs when there is a complete turn of the ovary, tube, or both resulting in impaired blood flow to the ovary. The diagnosis of adnexal torsion is sometimes challenging due to the enlarged effect of the uterus, the displacement of abdominal and pelvic structures and the nonspecific symptoms in pregnancy. Therefore, prompt diagnosis is essential for better maternal and neonatal outcomes. The gold standard for confirmation and treatment of ovarian torsion is surgery. Laparoscopy and Laparotomy are surgical options with defined risks and benefits. Therefore, choosing the best surgical technique and surgical procedure are of utmost importance to decrease the chances of adverse events intra and postoperatively. Little literature exists regarding the laparoscopic approach of an ovarian torsion during the second trimester. Our case is a 20-week pregnant patient who had a 1080 degree rotation of the left adnexa. She required laparoscopy for adnexal detorsion and had good intraoperative, postoperative, maternal, and neonatal outcomes following management.

Download Full-text