Adnexal torsion during pregnancy: A rare cause of acute abdomen

Abstract

Ovarian torsion is caused by rotation of the ovary or adnexa with the vascular pedicle on its axis resulting in arterial and venous obstruction. Here we report a case of a pregnant woman presented to the emergency department in early second trimester with acute abdomen. History revealed the presence of an ovarian mass detected by ultrasonography 6 months before pregnancy. Sonographic examination showed right adnexal mass with abnormal Doppler velocimetry and thus immediate laparotomy was decided. Right salpingo-oophorectomy was performed and post-operative course of the patient was uneventful. According to this case, adnexal torsion should not be eliminated from differential diagnosis when it comes to pregnant women with acute abdomen.

Ovarian cyst torsion in a pre-menopausal woman causing intestinal obstruction: a case report

“…Simple ovarian cysts are the most common non neoplastic adnexal masses among women of reproductive age [ 2 , 3 ]. Ovarian torsion can happen if an ovarian mass or cyst rotates the uteroovarian and the infundibulopelvic ligament and is rarer on the left side [ 1 ]. Intestinal obstruction due to ovarian torsion is a very occasional complication of ovarian cyst [ 4 , 5 ] and might be present through two mechanisms; either a giant ovarian mass may compress the bowel [ 2 ] or a loop of small and/or large bowel becomes adherent to the cyst and rotates with the torsion of the cyst [ 4 ].…”

“…Intestinal obstruction due to ovarian torsion is a very occasional complication of ovarian cyst [ 4 , 5 ] and might be present through two mechanisms; either a giant ovarian mass may compress the bowel [ 2 ] or a loop of small and/or large bowel becomes adherent to the cyst and rotates with the torsion of the cyst [ 4 ]. Although ovarian torsion during pregnancy is relatively rare, adnexal torsion during pregnancy has been reported [ 1 ], as well as intestinal obstruction during pregnancy caused by bilateral ovarian cystic teratoma [ 6 ]. The clinical symptoms of ovarian torsion are nonspecific such as abdominal or pelvic pain, nausea and vomiting [ 1 ], which is similar to intestinal obstruction clinical appearance; the latest includes nausea, vomiting, bloating, crampy, colicky abdominal pain and minimal or complete absence of flatus and bowel movements [ 4 ].…”

“…Although ovarian torsion during pregnancy is relatively rare, adnexal torsion during pregnancy has been reported [ 1 ], as well as intestinal obstruction during pregnancy caused by bilateral ovarian cystic teratoma [ 6 ]. The clinical symptoms of ovarian torsion are nonspecific such as abdominal or pelvic pain, nausea and vomiting [ 1 ], which is similar to intestinal obstruction clinical appearance; the latest includes nausea, vomiting, bloating, crampy, colicky abdominal pain and minimal or complete absence of flatus and bowel movements [ 4 ].…”

“…Ovarian torsion is caused by rotation of the ovary or adnexa with the vascular pedicle on its axes resulting in venous and arterial obstruction [ 1 ]. Torsion of the right adnexa occurs more commonly due to hypermobility of the right utero-ovarian ligament which is longer than the left.…”