Presentation
Patient presents with abdominal pain that started this morning. Pain is located in the lower right abdominal quadrant, sometimes sharp, sometimes dull in character. Nausea and vomiting are also present. No signs of constipation, no dysuria. This is the first day of her menstrual cycle with normal menorrhea. Earlier, an ovarian cyst was verified.
Patient Data
The right ovary is enlarged, measuring 7 x 6 cm in size, heterogeneous in structure, with cystic masses peripherally - follicles. Cranial and anterior to the right ovary, a larger cystic mass is seen, measuring 16.5 x 9 x 15 cm. Small amount of free fluid is found in the pelvis. The findings suggest torsion of the right ovary.
No signs of pneumoperitoneum or ileus.
Case Discussion
Ovarian torsion can affect females of all ages. It represents a gynecological emergency and, if untreated, results in ischemic changes of the ovary.
The presented patient, in particular, underwent right-side adnexectomy and ovariectomy due to irreversible ischemic changes. Commonly, both the ovary and fallopian tube are involved, while isolated torsion involving either part of the adnexa is rare (one in 1.5 million women). Torsions can also involve paratubal or paraovarian cysts.
Ovarian torsion occurs due an ovarian cyst or mass (usually a benign lesion over 5 cm in diameter) rotating both the infundibulopelvic ligament and the utero-ovarian ligament. Torsion of normal ovaries can also occur, particularly in premenarchal girls whose infundibulopelvic ligaments are elongated (the ligament shortens in puberty).
This case was presented to me by my dear coworker, Dr. Adrijana Perkunić.
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