DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20215114
Published: 2021-12-28

A rare case of ovarian torsion in a pregnant patient

Swati Kumari

Abstract


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.


Keywords


Ovarian torsion, Hyperstimulation, Oopherectomy, Oopheropexy

Full Text:

PDF

References


Hibbard L. Adnexal torsion. Am J Obstet Gynecol. 1985;152:456-61.

Lee CH, Raman S, Sivanesaratnam V. Torsion of ovarian tumors: a clinicopathological study. Int J Gynaecol Obstet. 1989;28(1):21-5.

Mashiach S, Bider D, Moran O, Goldenberg M, Ben-Rafael Z. Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy. Fertil Steril. 1990;53(1):76-80.

Ventolini G, Hunter L, Drollinger D, Hurd WW. Ovarian torsion during pregnancy. 2007. Available at: https://www.hcplive.com/view/2005-09_04. Accessed on 14 August 2021.

Hasson J, Tsafrir Z, Azem F, Bar-On S, Almog B, Mashiach R, Seidman D, Lessing JB, Grisaru D. Comparison of adnexal torsion between pregnant and nonpregnant women. Am J Obstet Gynecol. 2010;202(6):536.

Arena S, Canonico S, Luzi G, Epicoco G, Brusco GF, Affronti G. Ovarian torsion in in vitro fertilization-induced twin pregnancy: combination of Doppler ultrasound and laparoscopy in diagnosis and treatment can quickly solve the case. Fertil Steril. 2009;92(4):1496.

Bouguizane S, Bibi H, Farhat Y, Dhifallah S, Darraji F, Hidar S, Lassoued L, Chaieb A, Khairi H. Les torsions des annexes de l'utérus. Aspects cliniques et thérapeutiques: à propos d'une série de 135 cas [Adnexal torsion: a report of 135 cases]. J Gynecol Obstet Biol Reprod (Paris). 2003;32(6):535-40.

Mashiach R, Bar-On S, Boyko V, Stockheim D, Goldenberg M, Schiff E, et al. Sudden/nocturnal onset of acute abdominal pain, lasting less than a day and accompanied by vomiting: a tell-tale sign of ovarian torsion. Gynecol Surg. 2010;297-301.

Smorgick N, Barel O, Halperin R, Schneider D, Pansky M. Laparoscopic removal of adnexal cysts: is it possible to decrease inadvertent intraoperative rupture rate? Am J Obstet Gynecol. 2009;200(3):237.

Hasson J, Tsafrir Z, Azem F, Bar-On S, Almog B, Mashiach R, Seidman D, Lessing JB, Grisaru D. Comparison of adnexal torsion between pregnant and nonpregnant women. Am J Obstet Gynecol. 2010;202(6):536.

Rackow BW, Patrizio P. Successful pregnancy complicated by early and late adnexal torsion after in vitro fertilization. Fertil Steril. 2007;87(3):697.

Smith LP, Oskowitz SP, Barrett B, Bayer SR. IVF and embryo development subsequent to ovarian torsion occurring during the resumption of meiosis. Reprod Biomed Online. 2010;21(3):418-21.

Oelsner G, Cohen SB, Soriano D, Admon D, Mashiach S, Carp H. Minimal surgery for the twisted ischaemic adnexa can preserve ovarian function. Hum Reprod. 2003;18(12):2599-602.

Pritts EA, Atwood AK. Luteal phase support in infertility treatment: a meta-analysis of the randomized trials. Hum Reprod. 2002;17(9):2287-99.

Bourgain C, Devroey P, Van Waesberghe L, Smitz J, Van Steirteghem AC. Effects of natural progesterone on the morphology of the endometrium in patients with primary ovarian failure. Hum Reprod. 1990;5(5):537-43.

Cicinelli E, de Ziegler D, Bulletti C, Matteo MG, Schonauer LM, Galantino P. Direct transport of progesterone from vagina to uterus. Obstet Gynecol. 2000;95(3):403-6.