Abstract
Adnexal torsion is a twisting of the adnexa, including the ovary and/or the fallopian tube, around its own vascular axis. Most cases of adnexal torsion occur in women of reproductive age and only rarely in postmenopausal women. Here, we report a case of 58-year-old woman, postmenopausal for 6 years, who presented with acute lower abdominal pain. Ultrasound scan showed a right-sided, well-circumscribed, cystic mass measuring 50x57 mm with low level echoes. Doppler evaluation revealed no blood flow signals inside the mass. Abdominal exploration revealed right adnexal torsion. Salpingo-oophorectomy was done and histopathological examination revealed a twisted, gangrenous hydrosalpinx with no pathological lesion in the ovary. The patient was discharged on the fourth postoperative day. Although adnexal torsion in postmenopausal women is a rare event, it should not be ignored in those women who present with abdominal pain. A longer delay between admission and surgery may be attributed to the rarity and non-specific symptoms of the disease in this age group.
Highlights
Adnexal torsion is defined as twisting of the adnexa, including ovary and/or fallopian tube, around its own vascular axis
Hydrosalpinx, a blocked, dilated, fluidfilled fallopian tube usually caused by a previous tubal infection, could be a risk factor.[9]
The wide differential diagnosis of an adnexal mass includes lesions of infectious origin, such as hydrosalpinx or tubo-ovarian abscesses caused by pelvic inflammatory disease (PID), endometriomas, both benign and malignant neoplasms, and physiologic or functional cysts and masses originating in organs adjacent to the adnexa.[10]
Summary
Adnexal torsion is defined as twisting of the adnexa, including ovary and/or fallopian tube, around its own vascular axis. Uncommon case of hydrosalpinx-induced adnexal torsion in a postmenopausal woman. Because the clinical symptoms of adnexal torsion are nonspecific, the diagnosis is considered to be difficult, and a correct preoperative diagnosis is made in only 44% of cases.[5] hydrosalpinx, a blocked, dilated, fluidfilled fallopian tube usually caused by a previous tubal infection, could be a risk factor.[9]. We report a case of a postmenopausal woman who presented with acute abdomen due to hydrosalpinx induced adnexal torsion. Abdominal and vaginal examination revealed a tense mass in the right adnexa. The mass was twisted twice on its pedicle (right adnexal torsion). Histopathological examination revealed a twisted, gangrenous hydrosalpinx with no pathological lesions in the ovary.
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