Bilateral ovarian torsion with ovarian fusion in the setting of polycystic ovarian syndrome: A case report

Synchronous bilateral ovarian torsion followed by recurrent unilateral torsion in a patient undergoing fertility treatment: A case report and literature review

BACKGROUND

Ovarian torsion (OT) is a gynaecological emergency and requires prompt recognition and treatment in order to prevent the loss of ovarian function. Patients who are undergoing fertility treatment are at an increased risk of developing OT.

OBJECTIVE

The diagnosis of OT in patients undergoing fertility treatment can be challenging as they often present with abdominal pain and other non-specific symptoms. We highlight the importance of early diagnosis of suspected torsion and performed a literature review on cases of bilateral OT to review its presentation, investigation, and subsequent management.

CASE REPORT

A 32-year-old nulliparous woman who was undergoing controlled ovarian stimulation presented with lower abdominal pain and was initially managed as ovarian hyperstimulation syndrome (OHSS). Her pain did not subside following conservative management and she proceeded to have a laparoscopy which demonstrated synchronous bilateral ovarian torsion (SBOT), both ovaries were detorted. Eight months later, she was preparing for her frozen embryo transfer (FET) cycle, patient again presented with significant right sided abdominal pain and was found to have a recurrent torsion of the right ovary which was again detorted successfully.

CONCLUSIONS

Clinicians should have a low-threshold to investigate and rule out OT in patients who present with lower abdominal pain, especially in those with additional risk factors for torsion. Patients with confirmed torsion can be successfully managed with detorsion of the ovaries. Further research is needed to determine the best management option for patients with recurrent torsion episodes.

Asynchronous Bilateral Adnexal Torsion: A Case Report

Adnexal torsion is a gynecological emergency that requires immediate surgical intervention to prevent permanent loss of the affected ovary. Here, we present a case of a 25-year-old female who presented to the emergency with a six-day history of lower abdominal pain. A computed tomography scan showed a clinical picture of ovarian torsion, hence, the patient underwent laparoscopic ovarian tissue-sparing right ovarian cystectomy with shortening of the right utero-ovarian ligament for a twisted right ovarian cyst. Intraoperatively, a left pelvic mass was seen sitting freely in the cul-de-sac, which was thought to be the left adnexa that possibly underwent complete torsion in the past, went unnoticed, and got amputated and separated from its pedicle. Postoperatively, the patient had a smooth recovery and was discharged within four days, in stable condition. Three months later, the patient began having her periods, though irregularly.

Ovarian torsion: can we save the ovary?

OBJECTIVE

The purpose of this study is to evaluate the correlation between visually appearing ovarian necrosis and necrosis in histopathology in patients with ovarian torsion; and to identify predictive factors of ovarian necrosis.

METHODS

This is a retrospective study. All women admitted to the hospital with a diagnosis of suspected ovarian torsion from January 2014 to December 2018 were recruited. Forty-two patients with a confirmed diagnosis of ovarian torsion were finally included. Correlation analysis was done between visual judgement of ovarian necrosis and necrosis in histopathology. Chi-square was performed to analyze dependence between time from pain onset to surgery, ovarian size in ultrasound, Doppler flow, and histopathological analysis.

RESULTS

Thirty-one ovaries were visually judged as necrotic. Only five of them (16%) had histopathologically confirmed necrosis, 20 (64.5%) had hemorrhage or congestion, and 6 (19%) had normal ovarian tissue, p = 0.349. Development of ovarian necrosis showed to be dependent on time from onset of pain to surgery. All patients with necrotic ovaries in histopathology underwent surgery after 24 h of pain onset, while there was no necrosis in those who had surgery before 24 h. (p =  < 0.05). There was no relationship between ovarian size measured by ultrasound and necrosis (p = 0.265), as well as color flow in ultrasound and necrosis (p = 0.388).

CONCLUSION

Visual assessment of ovarian necrosis intraoperatively is not a good predictor of real necrosis in histopathology. To preserve the ovary, surgical management should not be delayed.