Third trimester ovarian torsion

Ovarian torsion in the third trimester of pregnancy leading to a midline laparotomy and caesarean section for the delivery of a preterm baby is an uncommon event. As the woman is likely to present with nonspecific symptoms of lower abdominal pain, nausea, and vomiting, ovarian torsion can often be misdiagnosed as appendicitis or preterm labour. Treatment and the opportunity to preserve the tube and ovary may consequently be delayed. We report the case of a multiparous woman who had undergone two previous caesarean sections at term, presenting at 35 weeks of gestation with a presumptive diagnosis of acute appendicitis. Ultrasonography described a cystic lesion 6 × 3 cm in the right adnexa, potentially a degenerating fibroid or a torted right ovary. MRI of the pelvis was unable to provide further clarity. The patient was managed by midline laparotomy and simultaneous detorsion of the ovarian pedicle and ovarian cystectomy together with caesarean section of a preterm infant. This report describes that prompt recognition and ensuring intraoperative access can achieve a successful maternal and fetal outcome in this rare and difficult scenario. Furthermore, we would like to emphasise that the risk for a pregnant woman and her newborn could be reduced by earlier diagnosis and management of ovarian masses (Krishnan et al., 2011).

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Ovarian torsion of a term pregnancy – a new twist: review of the literature and management

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2019-0048 ◽

2019 ◽

Vol 8 (2) ◽

Author(s):

Stephanie Trentacoste McNally

Keyword(s):

Case Report ◽

Ovarian Torsion ◽

Adnexal Torsion ◽

Third Trimester ◽

Lower Quadrant Pain ◽

Lower Quadrant ◽

Case Presentation ◽

The Third ◽

Acute Infarct ◽

History Of

Abstract Background Ovarian and adnexal torsions are gynecologic emergencies [Li Q, Li X, Zhang P. Ovarian torsion caused by hyperreactio luteinalis in the third trimester of pregnancy: a case report. Int J Clin Exp Med. 2015;8:19612–5; Ssi-Yan-Kai G, Rivain AL, Trichot C, Morcelet MC, Prevot S, Deffieux X. What every radiologist should know about adnexal torsion. Emerg Radiol. 2018;25:51–9; Huchon C, Fauconnier A. Adnexal torsion: a literature review. Eur J Obstet Gynecol Reprod Biol. 2010;150:8–12]. Case presentation Though rare in pregnancy, this case report describes a 32-year-old G0 at 39 + 3/7 weeks with a history of kidney stones and a simple ovarian cyst that presented to the labor floor with left lower quadrant pain. She underwent an induction of labor for persistent pain and had a subsequent primary section for a category II tracing. Conclusion During the section, a torsion x3 of the left infundibular ligament was noted. The pathology indicated an acute infarct – only one other case of a full-term torsion was found in the literature (Li Q, Li X, Zhang P. Ovarian torsion caused by hyperreactio luteinalis in the third trimester of pregnancy: a case report. Int J Clin Exp Med. 2015;8:19612–5).

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