A rare case of uterine torsion with bilateral ovarian torsion: a diagnostic challenge

Synchronous bilateral ovarian torsion is rare that too in nonpathological ovaries. To the best of our knowledge, this is the second case of synchronous bilateral ovarian torsion of nonpathological ovaries in adolescents. A 14-year-old girl presented with pain lower abdomen, vomiting, and constipation for the last 10 days. Ultrasonography (USG) suggested bilateral ovarian torsion without any ovarian pathology. Emergency laparoscopy confirmed bilateral ovarian torsion with necrosed-looking ovaries, and detorsion was done. During follow-up period, she had intermittent mild pain abdomen, and on USG, her left ovary returned to normal size, but her right ovary had been bulky throughout without any cyst. At around 10 months, the patient presented with severe abdomen pain. This time only right ovarian torsion was there. Laparoscopic bilateral ovarian detorsion with bilateral ovarian ligament plication was done. Ovarian torsion can be bilateral, even in nonpathological ovaries. Ovarian fixation should be done in these cases to prevent recurrent torsion.

BackgroundOf all patients undergoing emergency surgery for acute pelvic pain, approximately 2.7% of cases are caused by ovarian torsion. We report a rare occurrence of bilateral ovarian torsion in a young woman.Case presentationWe report the case of a 20-year-old white woman who presented with sudden onset of severe lower abdominal pain and nausea. Similar episodes of pain were experienced in the previous few months and diagnosed as a case of bilateral ovarian cyst. She was found to have a bilateral ovarian torsion caused by adnexal mass. She was treated by laparoscopic detorsion, left salpingo-oophorectomy, and right cystectomy.ConclusionThis case highlights the need to perform an early laparoscopic surgical intervention in cases of bilateral ovarian mass because of the greater chance for their torsion and subsequent effects on fertility.

Bilateral ovarian pathology and torsion in infancy: Assessment of pubertal and gonadal function

Ovarian/adnexal torsion is a rare gynaecological emergency presenting with nonspecific signs and symptoms mimicking other causes of acute abdomen. Asynchronous bilateral ovarian torsion is even rarer but has serious implications as it may potentially lead to castration. Traditionally, ovarian torsion has been treated by surgical resection; however, there is growing evidence that the ovary regains its function when detorsed and left in situ. We report a case of a bilateral asynchronous ovarian torsion in a young female that occurred after an interval of 8 years, which was managed by untwisting the pedicle and preserving the ovary. Key Words: Ovarian torsion, Castration, Bilateral, Gynaecological emergency.

Association Between Use of Pain Medication, Ultrasound Findings, and Adnexal Torsion Among Young Females Presenting With Acute Abdominal Pain

Simultaneous bilateral ovarian torsion in the follicular phase after gonadotropin stimulation

Acute abdomen in early pregnancy due to ovarian torsion following successful in vitro fertilization treatment

A 26-year-old primigravida with a singleton pregnancy of 9 weeks gestation presented with severe lower abdominal pain, following spontaneous hyperstimulation of the ovaries in a natural conception. Emergency laparoscopy was done and bilateral ovarian torsion with retained vascularity was noted. Bilateral detorsion with ovarian puncture and ovariopexy was performed. A review of international literature suggests that this is the first case reported with bilateral ovarian torsion following spontaneous ovarian hyperstimulation syndrome in a singleton pregnancy.

Torsion with infarction of a single normal ovary is rare. Bilateral torsion in a neonate is most unusual.1,2I describe a neonate with bilateral ovarian torsion who had massive abdominal swelling. Report of a Case.—A 1-month-old female infant was admitted to a hospital in September 1978 for massive abdominal swelling. The infant, delivered vaginally at term, had been kept in the nursery 11 days because of low birth weight (2,270 g) and a nonspecific neonatal dermatitis. Five days before this hospital admission, abdominal swelling and irritability developed for which a phenobarbital, hyoscyamine sulfate, atropine sulfate, and hyoscine hydrobromide combination in 23% alcohol and simethicone were prescribed. At admission, the infant appeared small for her age. Pulse rate was 160 beats per minute, respirations were 46/min and labored, and temperature was 36.6 °C. The abdomen was grossly distended, and prominent veins were visible over its surface. The abdominal organs

Neonatal Bilateral Testicular Torsion: A Plea for Emergency Exploration

Bilateral ovarian torsions with complete loss of ovaries is devastating. This study analyzed the literature on bilateral ovarian torsions in girls to evaluate surgical options and outcomes. Literature was searched on Pubmed® (1987-2014) using terms "bilateral", "adnexal", "ovary", "torsion" and "children". Data were collected on age, surgical preference, pathology and outcomes. Thirteen articles were identified, and 9 met the inclusion criteria (5 case reports, 4 original articles); and analyzed 17 girls (mean age: 8.75 years, range: 1-16). Bilateral oophorectomies (n=4), ipsilateral oophorectomy of severely affected ovary and contralateral oophoropexy (n=10), and detorsion of bilateral ovaries and bilateral oophoropexy (n=3) were performed. One torsion recurrence occurred after two oophoropexies. Laparoscopy and open surgery was done in 2 and 15 girls, respectively. Considering etiology, there were simple tubo-ovarian torsions (n=8), polycystic ovary (n=1), polycystic ovary associated with Down syndrome (n=1) and corpus luteum cyst (n=1). No tumors were reported. Serial ultrasound follow-ups of ipsilateral oophorectomy and contralateral oophoropexy (n=5) confirmed follicular function (n=4) and viability and position of the ovary (n=1). Though extremely rare, school age girls present bilateral ovarian torsion. Ipsilateral oophorectomy and contralateral detorsion with oophoropexy has been the preferred approach.

Salvage of Bilateral Asynchronous Perinatal Testicular Torsion

Signal peptide-CUB-EGF (epidermal growth factor-like protein) domain-containing protein 1 (SCUBE1) is an experimental marker of ischemia that has been previously studied both in rat models and humans. In this study, we aim to investigate the importance of SCUBE1 levels in ovarian torsion using an ovarian torsion model in rats. A total of 18 Sprague-Dawley rats were equally divided into three groups. Group 1 (n = 6) was the Sham group and was only given a laparotomy procedure. Group 2 (n = 6) underwent bilateral ovarian torsion and ovarian ischemia lasting 8 h. Group 3 (n = 6) was subjected to bilateral ovarian torsion and ischemia lasting 24 h. Blood samples were collected from all three groups after the operations, and SCUBE1 levels were studied. Ovarian samples were collected, and microscopic evaluation was performed. The correlation of SCUBE1 levels and histopathological findings were investigated. The mean SCUBE1 level of group 3 was statistically higher than other groups (P < 0.01). Follicular degeneration and infiltration of inflammatory cells were, respectively, statistically significant in groups 2 and 3 (P = 0.002 and P = 0.045, respectively). SCUBE1 can be useful in diagnosing ovarian torsion during the first 24 h, but more randomized controlled studies are necessary in order to implement it in clinical settings.

Bilateral simultaneous ovarian torsion is rare in pediatric patients. We wanted to share the diagnosis, treatment and results of our patient with bilateral concurrent ovarian torsion with the literature.The three-month-old girl was brought to the emergency room because of unrest for 2 days. Doppler ultrasonography showed no vascularity in bilateral ovaries. The patient was taken into operation immediately. Detorsion was applied to both ovaries. Although the blood circulation of the ovaries did not improve, the ovaries were preserved and no oophorectomy was performed. In the postoperative follow-up, the blood supply of the right ovary began to be observed. The patient is still in follow-up and right ovarian blood supply continues. We presented the 4th case in the literature due to bilateral synchronized ovarian torsion. We wanted to present that the ovarian protective approach in these patients' surgery may be satisfying even in a limited case.

Adnexal torsion is a well-recognized gynecologic emergency; however, uterine torsion is less well-known. The majority of uterine torsions occur in gravid uteri; torsion in postmenopausal patients is rare. We report a case of uterine and bilateral adnexal torsion in a postmenopausal woman due to a large leiomyoma. This patient presented to the emergency department with acute onset pelvic pain in the setting of a known pelvic mass. Imaging findings were significant for a large pelvic mass that differed in location when compared to prior imaging. In addition, the cervix had a "twisted" appearance on imaging. Overall these findings were suspicious for uterine torsion, and surgical management was planned. Operative findings were significant for 720-degree uterine torsion at the level of the lower uterine segment due to a large subserosal fibroid extending into the left broad ligament. Pathology was significant for confirmed leiomyoma measuring 25 cm, with edema and myxoid changes, uterus and bilateral ovaries with hemorrhage and congestion, all of which supported the diagnosis of uterine torsion, which also resulted in bilateral adnexal torsion. This case demonstrates an instance of uterine and bilateral adnexal torsion that was managed in a timely fashion. If surgical treatment is delayed, grave sequelae can occur. Consideration of concomitant uterine and adnexal torsion during an acute pelvic pain workup is crucial to ensure appropriate inpatient management, preoperative counseling, surgical consent, and patient safety.