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.

Susceptibility-weighted MR sequence for the evaluation of ovarian masses with torsion

Objective: Adnexal torsion is a rare gynecologic emergency caused by twisting of an adnexal mass. Twisted vascular pedicle is the most specific imaging finding for adnexal torsion, however, identification of twisted vascular pedicle can be challenging. The purpose of this study is to evaluate the feasibility of susceptibility-weighted MR sequence (SWS) for the diagnosis of adnexal torsion. Methods: MR imaging including SWS (SWAN: susceptibility-weighted angiography) of surgically proven four benign ovarian masses with torsion (one acute and three subacute to chronic torsions) were retrospectively evaluated. Three cystic masses and one solid mass were included in this study. Results: High signal intensity venous thrombus within the twisted vascular pedicle on T1-weighted imaging (T1WI) was detected in three lesions with subacute to chronic torsion (75%) but not in one lesion with acute torsion, whereas susceptibility-induced signal voids within the twisted vascular pedicle on SWAN were detected in all four lesions (100%). Conclusion: The demonstration of venous thrombus in the twisted vascular pedicle by SWS may be diagnostic for adnexal torsion. Advances in knowledge: SWS can detect blood products sensitively and can reveal venous thrombus in the twisted vascular pedicle, which may be helpful for the diagnosis of adnexal torsion.

How to Approach to Torsional Adnexal Mass in a Geriatric Age Woman: A Case Report and Literature Review

We aimed to present how to approach to the postmenopausal torsional adnexal masses, accompanied by a case report and literature review. A 90 year-old geriatric age woman with G5P5 admitted to emergency department with complaints of nausea, vomiting and abdominal pain. We detected a tumoral mass with solid component and irregular surface suspected malignancy in the midline of the pelvis. Laparotomy was performed due to the suspicion of torsion and malignancy. We detected a approximately 25 cm torsional blue-purple colored tumoral mass originating from the right ovary and performed total abdominal hysterectomy and bilateral salpingo-oferectomy. Pathology was reported as a sex cord stromal tumor with torsional. The patient was discharged with complete recovery on the 3rd postoperative day. Adnexal torsion is a gynecologic emergency. It should be considered in postmenopausal women who present with abdominal pain and adnexal mass.

A New Etiologic Factor for Adnexal Torsion: Congenital Omental Fenestrum

<p>Torsion seen in ovary, fallopian tube or in both organs is one of the gynecologic emergency pathologies in patients suffering from acute lower abdominal pain, and it constitutes approximately 2.7% of gynecologic emergencies. Delays in diagnosis and treatment can cause ischemic damage, in that way can cause the risk of ovary, fallopian tube or both organs loss. Thus, it can result in fertility problems in people who are desiring future fertility.<br />Although the etiology is not totally known, it has been thought that torsion risk has been increasing in benign cystic teratomas and ovarian tumors. It can be also seen in congenital situations such as vitellointestinal duct anomaly and people who have undergone pelvic surgery.<br />In this article, a case for adnexal torsion developed in congenital omental fenestrum which is considered as a new factor for torsion etiology, was explained.</p>