Presentation
Right lower abdominal pain with vomiting for the last 12 hours.
Patient Data
Enlarged right ovary (70 x 44 x 37 mm - 61 cc) with altered parenchyma. Ill-defined areas of hypo and hyperechogenicity in the parenchyma without large follicle/ cyst/other mass lesions. Echogenic rim involving small follicles. No flow in the parenchyma. A twisted vascular pedicle is adjacent to the right ovary (seen in transabdominal as well as transvaginal scan).
Right Fallopian tube dilatation with edema; just cranial to the enlarged right ovary. It was reported as possibly spared from the torsion.
Left ovary (28 x 17 x 14 mm - 4 cc) with normal follicular pattern, normal parenchyma with flow signals. Retroverted uterus without mass lesion. No endometrial collection/ thickening.
Rim of fluid with tiny echoes in the pelvis.
The appendix was normal (images not documented). Normal rest of the abdominal study.
An emergency laparoscopy was done. Right ovarian as well as tubal torsion were present. The non-viable right ovary was removed along with the right Fallopian tube. The left ovary was normal and oophoropexy was done.
Photo of the enlarged discolored right ovary. 1st and 2nd videos show an abnormal ovary posterior to the uterus. 3rd video shows an edematous, discolored right Fallopian tube similar to the right ovary.
Case Discussion
The case shows right ovarian and tubal torsion with infarction.
Laparoscopy courtesy: operating surgeon Dr. Anjana N. Patel.
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