Adnexal Torsion During the Second Trimester of Pregnancy: Mc Burney Incision and Management Strategy

doi:10.33696/gynaecology.2.022

Abstract

A 33-year-old pregnant woman at 26 weeks gestation presented with abdominal pain in the right iliac fossa. She had a history of a left ovarian cyst. The current pregnancy was normal. The patient was apyretic. Laboratory testing revealed no inflammatory syndrome (leukocyte count of 10G/L and pro c reactive levels were 8 mg/L). In the absence of a diagnosis and given a non-contributory abdominal ultrasound, MRI was requested and revealed a right ovarian teratoma measuring 55 × 73 mm. A surgical exploration of the abdominal cavity (Mc Burney point) using tocolytic treatment with atosiban and after fetal maturation by intramuscular injection of betamethasone 12 mg was made. Pelvic exploration performed under general anesthesia found a right adnexal torsion. Anatomopathology found a 6 cm right ovarian cystic mature teratoma with no signs of malignancy. The rest of the pregnancy went smoothly. The patient gave birth at 39 SA + 4 days to a healthy boy weighing 3080 g

Highlights

Adnexal torsion during pregnancy is a rare pathology
The persistent pain was not relieved with level 2 analgesics and required a titration of morphine without point of call found; an abdominal ultrasound was carried out
The prevalence of adnexal torsion masses during pregnancy has been estimated to lie between 1/76 and 1/2328 births [1]; torsion is a rare pathology with an incidence of 1/5000 pregnancies [2]

Summary

Introduction

Adnexal torsion during pregnancy is a rare pathology. It is difficult to diagnose because of anatomical changes induced by the increase in uterine volume. Magnetic resonance imaging (MRI) showed a right ovarian teratoma 55 mm x 73 mm in size, with an ovary projected forward to the sub-parietal (Figure 1a)

Objectives

Findings

Conclusion