Acute onset of left iliac fossa pain.
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The left ovary is grossly enlarged and abnormally positioned in the pouch of Douglas. The left ovary appears mildy echogenic with small peripheral cysts likely to reflect stromal edema secondary to venous congestion. There is absence of vascular flow on color Doppler. Small volume free fluid is present in the pelvis.
The right ovary appears normal.
This is a classic case of left ovarian torsion. The torted ovary frequently flips posteromedially into the Pouch of Douglas and this is an important ancillary finding frequently under recognized.
The patient underwent urgent laparosopic detorsion procedure but unfortunately the left ovary was non-viable.