3 hours of left lower quadrant abdominal pain and nausea. Negative beta-HCG.
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Transvaginal pelvis ultrasound was performed, demonstrating:
- enlarged left ovary that is very tender to ultrasound probe palpation
- large anechoic cyst on the left ovary
- no vascular flow in the left ovary
- normal sized, non-tender right ovary with > 18 follicles
- anteverted, mobile, non-tender uterus with normal appearance of the endometrium
These ultrasound findings are consistent with left ovarian torsion. The patient was referred urgently to the Gynecology unit.
The patient proceeded to the operating theater under the Gynecology unit, where a laparoscopy was performed. The left ovary was confirmed to be torted twice around, with a blue/black appearance. The ovary and adnexa were detorted and the color subsequently improved. The large left ovarian simple cyst was drained. The uterus, right uterine tube and right ovary had normal appearance on laparoscopy.
Case thanks to Dr Alex Jarema and Dr Shamen Gunawardena.