Ovarian torsion in infertility management - Missing the diagnosis means losing the ovary: A high price to pay

Abstract

Ovarian torsion is a rare entity and the diagnosis is commonly missed. Here we present a series of two cases of ovarian torsion. First case followed the in vitro fertilization treatment, along with ovarian hyperstimulation syndrome, where even with timely intervention and laparoscopy, we had to compromise one ovary. Second case followed the ovulation induction and intrauterine insemination – where timely intervention helped us to save the ovary.

The Effect of Controlled Reperfusion in the Prevention of Infertility Caused by Ischemia Induced in the Contralateral Ovary in Rats with Unilateral Ovariectomy

“…Torsion in the contralateral ovary may lead to sterility in girls who have undergone unilateral ovariectomy. Early diagnosis and treatment of ovarian torsion therefore plays an important role in the preservation of ovarian functions [4]. Detorsion of the twisted adnexa and evaluation of the tissue reperfusion are proposed to prevent future infertility in the case of adnexal torsion.…”

Errors in imaging the pregnant patient with acute abdomen

“…Torsion is considered the 5th common gynecological emergency occurring in approximately 1 per 1800 pregnancies and in about 7% of already known ovarian masses, more frequently in the first and early second trimesters when the uterus rapidly increases in size [16,40]. It is more frequent (60%) in the right than in the left side because of the longer right utero-ovarian ligament and the reduced mobility of the left ovary due to the sigmoid colon [39]. The diagnosis must always be suspected when an ovarian mass is found in a pregnant women suffering from severe, localized or radiated, abdominal or pelvic pain, nausea, and/or vomiting [41].…”

“…Predisposing factors are pregnancy, ovarian, or paraovarian benign or malignant tumors, hormoneinduced ovulation, anatomic, and physiological abnormalities of the salpinx. It is estimated that pregnant women represent 12-25% of women with torsion [39]. Torsion is considered the 5th common gynecological emergency occurring in approximately 1 per 1800 pregnancies and in about 7% of already known ovarian masses, more frequently in the first and early second trimesters when the uterus rapidly increases in size [16,40].…”

Laparoscope- Lots of Hope And Scope

“…However this case clearly demonstrates that it can occur and needs to be considered as a differential diagnosis when patients present with an acute abdomen. Although conservative treatment has been proposed during pregnancy, surgical intervention is the treatment of choice once ovarian torsion is highly suspected [5]. Ultrasound scan examinations in early pregnancy should also address the cervix and the adnexa leading to early diagnosis and management of ovarian masses, thus avoiding later emergency situations and the possibility of preterm deliveries.…”