Presentation
Left lower quadrant pain after intrauterine insemination (IUI) procedure.
Patient Data
Retrouterine enlarged left ovary measuring 8.5 x 6.7 x 7.9 cm, exhibiting a hypodense center and peripherally-located follicles. There is a 4.4 x 4.0 x 5.1 cm cyst at its right edge and a smaller, twisted, enhancing structure that could represent a ruptured corpus luteum.
Very small amount of free fluid between the left ovary and the uterus and above the ovary.
Intramural fibroid measuring 2.7 x 3.6 x 3.1 cm, displacing endometrium posteriorly.
Atrophic right ovary.
Bartholin cyst bilaterally, right larger than left.
Impression:
Markedly enlarged left ovary showing features consistent with ovarian torsion.
Case Discussion
Complained of colicky left lower abdominal pain that started several hours after undergoing intrauterine insemination (IUI), for which she had injected herself with follicle-stimulating hormone (FSH) for 10 days.
Due to suspicion of left renal colic, US kidneys was done and reported as normal, except for a minute amount of free fluid in the Douglas pouch. Underwent CT abdomen (shown) for further evaluation. High suspicion for left ovarian torsion at CT prompted an urgent transvaginal ultrasound (TVUS) which verified the findings at CT.
At laparoscopy, the adnexa was "twisted on itself two full turns" and was detorsed.
Interestingly, a TVUS was done right before IUI and interpreted as normal, with a corpus luteum in the left ovary.