Adnexial Torsion and Infundibulo-Pelvic Ligament Absence During Primary Caesarean: Case Report

Abstract

The purpose of this study is to emphasize the importance of evaluation of adnexal structures and neighboring organs during cesarean operation. It is necessary to evaluate adhesions due to congenital anomalies, ovarian cysts, ovarian premalign masses, teratomas, morgagni cysts, ligamentum latum myoma, endometriosis, and past pelvic inflammatory disease (PID) that may be present during the operation. This evaluation will help prevent the development of acute abdomen due to unexplained pelvic pain or adnexial torsion in the postoperative patient. The 30 years old patient PK, gravida 1, visited our clinic for the first time at the 36th week. The patient did not have any complaints during the one-month follow-up at our hospital and complications did not develop. During 40 weeks plus 1 day of her pregnancy, head pelvis incompatibility was detected in the examination of the patient and she was admitted to the cesarean operation. The patient who had no history of previous intra-abdominal surgery, was underwent intraabdominal control after the uterus was closed during cesarean operation. Left tuba, over and tuba-ovarian relation were normal. The right tuba was torsioned 3 times around itself and was lack of right infundibulo-pelvic ligament, and also, over was at the distal end of the tuba. The fimbrial tip of tuba and over adhered to the sacrouterin ligament in the posterior uterus via a fibrous band without avascularity. Adhesion was opened and right adnexial detorsion was performed. Since the overlying tissue at the end of the tuba was mobil, the right adnexal was fixed again to the adhesion zone. The patient was discharged on the second postoperative day without any complications. Adnexal structures and neighboring organs should be checked during cesarean section. This control will prevent the unexplained abdominal pain and acute abdomen that may occur after the operation, and will help early detection of possible additional pathologies.