Ovarian cystic teratoma torsion in pregnancy

Abstract

Acute abdominal pain during pregnancy is encountered frequently and the differential diagnosis is extensive. Acute ovarian torsion in a pregnant patient is rare and is difficult to diagnose. Infarction caused by ovarian torsion will result if the twist is not unwound spontaneously or surgically in a timely fashion. The case is described of a 28-year-old primigravida who originally presented to the emergency department with right lower abdominal pain. The patient was ultimately found to have an extremely large cystic teratoma of the right ovary with concomitant torsion. Bedside ultrasonography is a highly accessible tool that can be used in a pregnant woman for screening a mass or ascites. Laparoscopic surgery has now been accepted as a safe modality for definitive diagnosis and therapeutic intervention. Because acute ovarian torsion is not encountered frequently, timely diagnosis is required to prevent mortality and minimise morbidity. It is important to keep ovarian torsion in the differential diagnosis of any pregnant woman with acute abdominal pain. Emergency physicians should be aware of the possibility of acute ovarian torsion in pregnant women and should have a high index of suspicion. Early surgical intervention should be undertaken.

Ovarian Cystic Teratoma in Pregnant Women: Conservative Management or Prophylactic Oophorectomy?

“…The differential diagnosis of abdominal pain during pregnancy can be quite challenging due to vast etiologies including appendicitis, diverticulitis, ureteral colic, ectopic pregnancy, and degenerative pedunculated fibroid. Infrequently torsion of the ovary due to ovarian masses [ 3 ]. Due to the gravid uterus, maternal anatomy also distorts the location and presentation of pelvic pain.…”

Torsion of a large ovarian dermoid cyst in the second trimester of pregnancy and its management: a case report

“…The differential diagnosis of acute abdominal pain is widespread during pregnancy and includes ectopic pregnancy, appendicitis, ureteral colic, pelvic inflammatory disease and, torsion of the ovary due to ovarian masses. 7 Ovarian masses are common in pregnant women. Sherard declared that the average age at ovarian mass diagnosis and surgery in pregnancy is 12 and 20 weeks, respectively.…”

“…Ovarian torsion occurs when the ovary twists in its vascular pedicle. 7 The diagnosis and treatment of the ovarian dermoid cysts in pregnancy have been reported in some studies. Tan et al described a 28-year-old pregnant woman with a gestational age of 11 weeks with a large cystic teratoma of the right ovary with concomitant torsion.…”

“…Right ovarian cystectomy was performed successfully via laparoscopy. 7 Chaudhary et al, 11 presented a case report of a ruptured dermoid cyst measuring 5×6cm in ultrasound in a pregnant woman with a gestational age of 24 weeks. The ruptured dermoid cyst in the left ovary was removed in laparotomy.…”

“…Laparoscopy reduces pain, shortens bleeding, and healing time. 7 Laparotomy may be more appropriate if the ovarian masses are large and contain solid components (such as a mature cystic teratoma). 5,6 The maximal size of the cyst that is an indication for laparotomy is controversial.…”