A Twist of Fate: Laparoscopic Management of Recurrent Ovarian Torsion

Abstract

<h3>Study Objective</h3> To describe and demonstrate laparoscopic oophoropexy techniques in a patient with recurrent ovarian torsion <h3>Design</h3> Surgical video presentation. <h3>Setting</h3> Academic tertiary care center. <h3>Patients or Participants</h3> This is a 22-yo nulliparous patient who had 3 episodes of recurrent ovarian torsion. Pelvic ultrasound between each ovarian torsion presentation showed normal doppler flow, however the ovary remained enlarged. <h3>Interventions</h3> For her first episode of ovarian torsion, the patient underwent a diagnostic laparoscopy with detorsion of the right adnexa and a right oophorpexy, where the utero-ovarian ligament was attached to the ovarian parenchyma using a single mattress suture. 10 months later she presented with another episode of ovarian torsion and was consented for laparoscopic right ovarian detorsion and oophoropexy. Due to the patient's now second episode of right ovarian torsion, her oophorpexy was performed using permanent suture and attaching the utero-ovarian ligament to the round ligament and ovarian stroma. 4 months after her second oophoropexy the patient presented with another episode of right ovarian torsion. She declined a third oophoropexy and opted for a right oophorectomy. <h3>Measurements and Main Results</h3> The patient recovered well after each surgical intervention for her ovarian torsion and was discharged on the same day of her operations. Pathology report from the right ovary showed a benign ovary with vascular congestion and marked edema, consistent with the clinical history of ovarian torsion. <h3>Conclusion</h3> This case of recurrent ovarian torsion is unusual in that there were two failed oophoropexy attempts and no ovarian cyst present. Even though our patient opted for an oophorectomy after her third ovarian torsion; laparoscopic detorsion and oophoropexy remains the best management option for recurrent ovarian torsion.