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.

Comparison of Ultrasonography with other Imaging Modalities for Detection of Adnexal Torosion: A Systematic Review

Background: Adnexal Torsion (AT), serious emergency of gynecology, frequently shows among nonspecific signs prominent to late analysis. Aim: To compare the test accuracy of Ultrasound, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) for diagnosis of adnexal torsion. Methodology: We observed google scholar as well as Radiographics key till Dec 2019. Assortment standards studies report upon Imaging Modality accuracy (index test) within paediatric and adult females alleged of adnexal torsion matched by clinical analysis or usual clinical or radiological follow up duration till symptoms firmness (reference standard). Results: We mark off 3836 references, comprised 18 Studies (1654 females, 665-cases), as well as comprised 15 into meta analyses, ultrasound pooled-sensitivity (n =12, 1187 females) was 0.79 (95% CI= 0.63 to 0.92) as well as specificity was 0.76 (95% CI= 0.54 to 0.93), by means of positive as well as negative probability fractions 4.35 (95% CI= 2.03 to 9.32) and 0.29 (95% CI= 0.13 to 0.66), correspondingly. By Doppler Ultrasound (n=7, 845 females) produced alike and specificity (0.88, 95% CI= 0.72 to 1.00) and sensitivity (0.80, 95% CI= 0.67 to 0.93). For magnetic resonance imaging (n=3, 99 females), pooled-sensitivity was 0.81 (95% CI=0.63 to 0.91) as well as specificity was 0.91 (95% CI= 0.80 to 0.96). Meta-analysis for Computed Tomography was impossible by 2 case control-studies as well as one cohort-study (n=3, 232 females). Its range of sensitivity was 0.74 to 0.95 as well as specificity 0.80 to 0.90. Conclusions: As a first line analytic examination for alleged AT, ultrasound has good performance. Increment in quantity of AT cases needs precise, rapid, as well as correct analytic extent. It has been utmost popular method as allied with further Imaging Modalities. MRI might compromise better specificity for investigating intricate morphology of ovary, nonetheless further proof is wanted. Beside with medical doubt as well as approximations. This study will offer sufficient appreciated evidence to understand sonographic markers impact during OT analysis precisely. Keywords: Adnexa, Computed Tomography, Doppler, Magnetic Resonance Imaging, Meta-analysis, Ovary, Test Accuracy,