Abstract
A 24-year-old women, presented with complaints of acute onset lower abdominal pain and vomiting. On clinical examination, a tender mass in the hypogastric region was palpable. Pelvic examination revealed the same mass felt anterior and through the right fornix, along with cervical motion tenderness. She missed her last periods and urine pregnancy test was weakly positive. Laboratory examination included a β-hCG assay with results of 39.8, haemoglobin level of 10.7, and white blood cell count of 9600. Ultrasonography revealed a cystic mass of size 9.9 × 8.5 cm in the right adnexa along with presence of heterogenous area of 5 × 8.2 cm with no vascularity with surrounding free fluid. A provisional diagnosis of chronic ectopic versus ovarian torsion was made as ultrasonographic findings were inconclusive of torsion. Exploratory laparotomy was done which revealed an enlarged, cyanotic and congested fallopian tube along with completely necrotic ovary on right side. Right salpingoopherectomy was performed because after untwisting of vascular pedicle there were no signs of reperfusion. The patient was discharged uneventfully on the fifth postoperative day. This case describes an interesting case of adnexal torsion along with pregnancy which was being misdiagnosed as chronic ectopic because of her positive urine pregnancy test and indeterminate ultrasound findings.
References
- Hibbard LT: Adnexal torsion. Am J Obstet Gynecol. 1985, 152: 456-461.
- Albayram F, Hamper UM. Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation. J Ultrasound Med 2001;20(10):1083–1089.
- Breech LL, Hillard PJ. Adnexal torsion in pediatric and adolescent girls. Curr Opin Obstet Gynecol 2005;17(5):483–489.
- Hata K, Hata T, Senoh D, et al. Change in ovarian arterial compliance during the human menstrual cycle assessed by Doppler ultrasound. Br J Obstet Gynaecol 1990;97(2):163–166.
- Hall DA, McCarthy KA, Kopans DB. Sonographic visualization of the normal post-menopausal ovary. J Ultrasound Med 1986;5(1):9–11.
- Ritchie WG. Sonographic evaluation of normal and induced ovulation. Radiology 1986;161(1):1–10.
- Bouguizane S, Bibi H, Farhat Y, et al. Adnexal torsion: a report of 135 cases. J Gynecol Obstet Biol Reprod 2003;32(6):535–540.
- Stark JE, Siegel MJ. Ovarian torsion in prepubertal and pubertal girls: sonographic findings. AJR Am J Roentgenol 1994;163(6):1479–1482.
- Graif M, Itzchak Y. Sonographic evaluation of ovarian torsion in childhood and adolescence. AJR Am J Roentgenol 1988;150(3):647–649.
- Yen CF, Lin SL, Murk W, Wang CJ, Lee CL, Soong YK, Arici A: Risk analysis of torsion and malignancy for adnexal mases during pregnancy. Fertil Steril. 2009, 91 (5): 1895-902.
- Kokoska ER, Keller MS, Weber TR. Acute ovarian torsion in children. Am J Surg. 2000 Dec;180(6):462-5.
- Oltmann SC, Fischer A, Barber R, Huang R, Hicks B, Garcia N. Cannot exclude torsion--a 15-year review. J Pediatr Surg. 2009 Jun;44(6):1212-6; discussion 1217.
- Rousseau V, Massicot R, Darwish AA, Sauvat F, Emond S, Thibaud E, Nihoul-Fekete C. Emergency management and conservative surgery of ovarian torsion in children: a report of 40 cases. J Pediatr Adolesc Gynecol. 2008 Aug;21(4):201-6.
- Hiller N, Appelbaum L, Simanovsky N, Lev-Sagi A, Aharoni D, Sella T. CT features of adnexal torsion. AJR 2007;189:124–9.
- Hasson J, Tsafrir Z, Azem F, et al. Comparison of adnexal torsion between pregnant and nonpregnant women. Am J Obstet Gynecol 2010;202:536.e1–6.
- Bar-On S, Mashiach R, Stockheim D, et al. Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate? Fertil Steril 2010;93:2012–5.
- Lee EJ, Kwon HC, Joo HJ, Suh JH, Fleischer AC. Diagnosis of ovarian torsion with color Doppler sonography: depiction of twisted vascular pedicle Ultrasound Med 1998;17(2):83–89.
- Vijayaraghavan SB. Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med 2004;23(12):1643–1649.
- Oelsner G, Shashar D. Adnexal torsion. Clin Obstet Gynecol 2006;49(3):459–463.
- Rha SE, Byun JY, Jung SE, et al. CT and MR imaging features of adnexal torsion. Radio Graphics 2002;22(2):283–294.
Corresponding Author
Monika Thakur
Assistant Professor, Department of Obstetrics and Gynaecology, DYSPGMC Nahan 173001 Himachal Pradesh, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i11.144
