Ovarian torsion with concomitant detorsion
Lower abdominal pain
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A thick walled cyst is seen in midline, which on ultrasound had diffuse low level internal echoes. The left ovary is seen separately ( not shown in these images). The right ovarian residual stroma is noted stretched around this cyst. The right adnexa on earlier ultrasound demonstrated no adnexal vascularity; however on post contrast images it appears to enhance brilliantly while no significant enhancement is noted in the cyst wall. Minimal free fluid was present in the POD. These features were in favor of torsion with concomittant de torsion.
An ovarian torsion is the rotation of the ovary and portion of the fallopian tube upon the supplying vascular pedicle. This can be intermittent or continuous which would result in venous, arterial and lymphatic stasis. It is a gynaecologcial emergency and it will require urgent surgical intervention to prevent ovarian necrosis. Spontaneous ovarian de torsion may occur which is relatively common.