Acute abdomen in early pregnancy caused by torsion of bilateral huge multiloculated ovarian cysts

Sathiyakala Rajendran, Suthanthira Devi


The association of pregnancy and torsion of bilateral huge benign ovarian cyst is rare. We report a case of multigravida at 13 weeks of pregnancy presenting with acute onset of lower abdominal pain. Ultrasound revealed bilateral multiloculated ovarian cysts of size 10x10 cm on right side and 15x10cm on left side with evidence of torsion and a single live intrauterine fetus of gestational age 13 weeks 4 days. Emergency laparotomy was done with vaginal susten 200 mg as perioperative tocolysis. Intra operatively, uterus was enlarged to 14 weeks size. Both ovaries were replaced with multiloculated cysts of size 15x10 cm on left side and 10x10 cm on right side. Ovarian pedicle was found to be twisted once on right side and twice on left side. On right side, untwisting of pedicle was done and the ovarian cyst was punctured at multiple sites to drain the clear fluid. Biopsy was taken from the right ovarian cyst wall. On left side, ovariotomy was done. Histopathology revealed mucinous cyst adenoma of left ovary and multiple corpus luteum in right ovarian biopsy specimen. The patient was followed up with regular antenatal check-ups and ultrasound to rule out the recurrence of ovarian cyst on right side. The patient successfully delivered a term male baby at 39 weeks.


Torsion of bilateral ovarian cyst, Huge mucinous cyst adenoma, Acute abdomen in pregnancy, Huge ovarian cyst

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Czekierdowski A, Bednarek W, Rogowska W, Kotarski J. Difficulties in differential diagnosis of adnexal masses during pregnancy: the role of grayscale and colour doppler sonography. Ginekol Pol. 2001;72:1281-6.

Ballard CA. Ovarian tumors associated with pregnancy termination patients. Am J Obstet Gynecol. 1984;149:384-7.

Goffinet F. Ovarian cysts and pregnancy. J Gynecol Obstet Biol Reprod. 2001;30(suppl 1):S100-8.

Zanetta G, Mariani E, Lissoni A, Ceruti P, TrioD, Strobelt N, Mariani S. A prospective study of the role of ultrasound in the management of adnexal masses in pregnancy. BJOG. 2003;110:578-83.

Stepp KJ, Tulikangas PK, Goldberg JM, Attaran M, Falcone T. Laparoscopy for adnexal masses in the second trimester of pregnancy. J Am Assoc Gynecol Laparosc. 2003;10(1):55-9.

Schmeler KM, Mayo smith WW, Peipert JF, Weitzen S, Manuel MD, Gordinier ME. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol. 2005;105:1098-103.

Tica VI, Tomescu A, Russu E, Beghim M, Tica I, Serbanescu L, Bafani S. Ovarian cyst and pregnancy conservative management and consecutive emergency cystectomy. Rev Med Chir Soc Med Nat Lasi. 2007;111(4):976-80.

Yen CF, Lin SL, Murk W, Wang CJ, Lee CL, Soong YK, Arici A. Risk analysis of torsion and malignancy for adnexal masses during pregnancy. 2009;91(5):1895-902.

Goh W, Bohrer J, Zalud I. Management of the adnexal mass in pregnancy. Curr Opin Obstet Gynecol. 2014;26(2):49-53.

Ngu SF, Cheung VYT, Pun TC. Surgical management of adnexal masses in pregnancy. JSLS. 2014;18(1):71-5.

de Haan J, Verheecke M, Amant F. Management of ovarian cysts and cancer in pregnancy. Facts views vis obgyn. 2015;7(1):25-31.