Left Ovarian Torsion Research Articles

An Unexpected Cause of Abdominal Pain in Pregnancy: A Case Report

Acute abdomen during pregnancy is a condition that requires rapid diagnosis and treatment and threatens both maternal and fetal health. Adnexal masses may present different clinical presentations during pregnancy. The important thing is rapid diagnosis and application of the appropriate treatment method. Adnexal torsion should be kept in mind in the differential diagnosis of patients presenting with acute abdomen during pregnancy. Early diagnosis and treatment are vital for organ-preserving surgery.
 In this article, we presented the successful treatment of a patient with laparoscopy surgery who applied to our clinic due to acute abdomen and was diagnosed with left ovarian torsion at 12 weeks' gestation.

Intrauterine left ovarian torsion located in the right abdominal quadrant: Case report

In this article, we will share our case of intrauterine left ovarian torsion located entirely in the right half of the abdomen and its features. She was admitted to the pediatric surgery outpatient clinic due to an intra-abdominal mass lesion. In her history, it was learned that she had a known and unclear diagnosis of an intrauterine mass for seven months. Abdominal magnetic resonance imaging was performed for the cross-sectional evaluation of the lesion. In the right lower quadrant of the abdomen, 35x30 millimeter septated T1 hypointense T2 hyperintense nodular lesion without contrast enhancement and a collection of fluid around the lesion were seen, extending posterior to the cecum and inferiorly to the right adnexal region in the right lower quadrant of the abdomen. The mass was excised by performing salpingoopherectomy. Today, more intrauterine problems can be detected thanks to pregnancy follow-ups and fetal imaging, and intrauterine torsion is one of the fetal pathologies that should be considered. Although the common approach is excision, we think that with the development of early postnatal or fetal surgery opportunities in the future, it will be possible to treat these lesions without causing organ loss.

Case Report on Left Ovarian Torsion: A Rare Complication in an Adolescent PCOS

Introduction: Ovarian torsion is an acute emergency and women in any age group having cysts may have this complication. With increase in number of women having PCOS mainly adolescent girls are also at risk of this complication. Here we report a case of young PCOS girl who presented with acute abdomen who was found to have left ovarian torsion. The emergency was managed by emergency laparoscopic derotation and oophoropexy.
 Main symptoms and clinical findings: A 14 year old girl with PCOS presented with severe pain over right lower abdomen and was associated with 2 episodes of non-bilious vomiting. On examination she was anxious with tachycardia of 104 bpm. Right iliac fossa was tender without any distension, guarding or rigidity.
 Main diagnoses, therapeutic interventions, and outcomes: Her lab investigation revealed leukocytosis with hormonal profile consistent with PCOS. On USG there was bulky left ovary of 7.9 x 5.5 x 4 cms and volume of 87cc with lack of arterial blood flow. She was promptly taken up for emergency laparoscopy where left ovary was rotated 360 degree clockwise with gangrenous looking cyst wall which improved on detorsion. Left ovary was then fixed to lateral pelvic wall in anatomical position.
 Conclusion: All adolescent girls with ovarian torsion but no apparent ovarian pathology should be tested for PCOS using ultrasound and biochemical tests. Also girls with known PCOS in this age group presenting with acute abdomen, ovarian torsion should be considered and promptly investigated.

6-Year-Old Girl With a Luteinized Follicular Ovarian Cyst and an Estradiol Level > 1,000 PG/ML

Background: Precocious puberty in girls is defined as onset of secondary sexual characteristics, such as breast development, before 8 years of age. To differentiate between central and peripheral precocious puberty, laboratory and imaging evaluation is helpful. When gonadotropins are low but estradiol is elevated, results may suggest a primary ovarian source of estrogen production. Small ovarian cysts are not uncommon, are benign and self-resolve. However, large ovarian cysts are rare, let alone ones requiring surgical removal. Clinical Case: A 6 year 7 month old girl presented with several days of breast tenderness and palpable bilateral breast tissue noted by her mother. There was no history of vaginal bleeding. There were no reported exposures to estrogen-containing products. Her mother reached menarche at age 14 years. The patient was born full term and was otherwise healthy. On exam, her height was at the 90-95th %ile (mid-parental height at the 95th %ile) and her growth velocity was 10.9 cm/yr. She had Tanner 2 breasts (1 cm breast bud on the left and 1.5 cm on the right), Tanner 1 pubic hair and no axillary hair, body odor, acne or café-au-lait macules. A bone age was read as 6 years at a chronological age of 6 years 7 months. A laboratory evaluation revealed an estradiol of 1,029 pg/mL (<15 pg/mL), LH <0.02 mIU/mL, FSH <0.09 mIU/mL, 17-hydroxyprogesterone (17-OHP) 410 ng/dL (<91 ng/dL), AFP 2.3 ng/mL (<6.1 ng/mL), beta-hCG <2 mIU/mL, TSH 2.41 mIU/L (0.5-3.2 mIU/L), and free T4 0.9 ng/dL (0.9-1.4 ng/dL). Pelvic ultrasound revealed a large unilocular cystic structure measuring 6.5 x 4.1 x 6.1 cm in the left adnexal region with no left ovary visualized. The right ovary appeared prepubertal. The uterus was prepubertal in appearance with endometrial thickness of 2 mm. Abdominal ultrasound showed no evidence of a suprarenal mass. A laparoscopic cyst resection was completed, given the risk of left ovarian torsion. Cytology was negative; pathology revealed a luteinized follicular cyst. Repeat labs in one month showed a prepubertal estradiol level of 6.7 pg/mL with LH 0.02 mIU/mL and FSH 0.38 mIU/mL. 17-OHP normalized to 29 ng/dL. Breast tissue had regressed. Conclusion: This case describes the rare finding of a large luteinized follicular ovarian cyst that required surgical removal in a 6-year-old girl in the setting of a significantly elevated estradiol level. Luteinized follicular cysts have been described in newborns, though rare. To our knowledge, this is the first described case of a luteinized follicular cyst in this patient’s age group. Laboratory and imaging evaluation should be considered in girls presenting with precocious puberty, despite the extent of thelarche, as the clinical examination does not always correlate with degree of estradiol elevation. This is especially important if clinical changes are acute and other features are consistent with puberty, such as rapid linear growth.

An Unusual Benign Vascular Ovarian Tumor

Ovarian hemangiomas are very rare benign tumors of the female genital tract. Most cases are small lesions that are discovered by chance. Although they are often an incidental finding at surgery, these lesions may sporadically be associated with systemic manifestations. Here, we describe a 63 year-old woman with a right ovary benign hemangioma who presented with a clinically suspicious left ovarian torsion.

Co-occurrence of Left Ovarian Torsion and Right Fallopian Tube Ectopic Pregnancy in One Patient: A Case Report

Co-occurrence of Left Ovarian Torsion and Right Fallopian Tube Ectopic Pregnancy in One Patient: A Case Report

Torsion of a large ovarian dermoid cyst in the second trimester of pregnancy and its management: a case report

Background: The Dermoid cyst is the most common ovarian germ cell tumor in pregnant women. During pregnancy, the risk of complications such as torsion, rupture,and infection increases in dermoid cysts. Treatment includes follow-up or surgical intervention. The present study reports a case of a large ovarian dermoid cyst in pregnancy and its treatment. Case report: An 18-year-old primiparous woman presented with nausea and severe abdominal pain in the lower left quadrant. On a deep abdominal examination, there was a palpable mass in the area. Ultrasound showed left ovarian torsion of a large dermoid cyst 10×11cm in size. The patient underwent a laparotomy and with the left ovary preserved, the cyst was removed. Ultrasound showed fetal health a few days after surgery. Conclusion: gynecologists should be aware of the possibility of acute ovarian torsion in pregnant women and should have a high level of suspicion. Early surgical intervention reduces the risk of complications

Large bilateral ovarian cysts with left ovarian torsion and right dermoid cyst.

We report the case of a 19-year-old patient, with medical history of hypothyroidism and nulligravida, who presented with acute pelvic pain progressing for 5 days. On clinical examination, the patient was stable and had pelvic tenderness. The speculum and vaginal examination were not performed on account of the patient being a virgin. A pelvic magnetic resonance imaging (MRI) was performed showing a cystic right ovarian lesion measuring 9.7 x 7 x 6 cm of benign appearance with swollen ovary probably related to a torsion; associated with a left ovarian lesion measuring 10 x 10 x 6 cm with a double cystic and fatty component in favor of a dermoid cyst (A,B,C). Surgical exploration showed two large bilateral ovarian cysts (D). The right ovary was the site of 3-whirl torsional ischemia. The left ovary presented with a large cyst with a fatty and fluid cartilaginous component (E). The uterus was unicorn with the presence of a rudimentary straight horn. The operative procedure consisted of a bilateral cystectomy with right salpingectomy in order to avoid an ectopic pregnancy on a rudimentary horn. The right ovary revascularized after untwisting and the postoperative course was normal.

Hypothyroidism Causing Precocious Puberty and Ovarian Torsion

Hypothyroidism in children causes delayed puberty. However longstanding untreated hypothyroidism can lead to precocious puberty which may be secondary to hyperprolactinemia or increased levels of thyroid stimulating hormone (TSH), enhancing the sensitivity of ovaries to circulating gonadotropins. Here we report a seven and half years old girl with hypothyroidism presenting with precocious puberty and multicystic ovaries which responded well to thyroid hormone supplementation but subsequently developed left ovarian torsion requiring surgical intervention.

Recurrent Ovarian Torsion in a Premenarchal Girl

A 10-year-old girl presented with a recurrence of left ovarian torsion where she presented with intermittent left sided abdominal pain for 2 days. She had a similar presentation occuring 1 month ago. The patient underwent successful ovarian salvage with laparoscopic left ovary detorsion and bilateral oophoropexy 5 hours after presentation. Tumour markers were not raised. Intraoperative incisional ovarian biopsy showed no evidence of malignancy. Ovarian torsion is a rare gynaecological emergency in children with nonspecific symptoms. Early recognition and surgery are important to prevent ovarian necrosis. The presentation of acute onset unilateral abdominal pain on the background of a similar previous presentation should alert the clinician of this diagnosis. Although ovarian torsions occur more commonly in the presence of adnexal masses more than 5cm in size, it can also occur in normal ovaries especially in the premenarchal age group. Laparoscopic detorsion is the treatment of choice with oophoropexy a feasible option for prevention of a recurrence. Close follow up with ovarian surveillance is required to ensure resolution of ovarian enlargement.

1457 Laparoscopic Single Port Uterine Ovarian Ligament Plication and Ovarian Fixation

Video Objective To demonstrate the technique of ovarian fixation and uterine ovarian ligament plication using single port laparoscopy. Setting This is a 25 year old Gravida 0 who presents with a history of worsening left lower quadrant pain. Patient's history is significant for prior left ovarian torsion x 2 requiring laparoscopic intervention. Interventions This video demonstrates the first single port laparoscopic uteroovarian ligament plication and ovarian fixation using techniques in which the needle is positioned in different orientations to overcome limited angles of attack seen in single port surgery. The ovarian fixation is done in a way previously described in multiport laparoscopic surgery but not before in single port surgery. Novel knot tying techniques demonstrated as well. Conclusion Single port laparoscopy can be used in advanced laparoscopic procedures such as uteroovarian ligament plication and ovarian fixation.

Adnexal Torsion with Dystrophic Calcifications in an Adolescent: A Chronic Entity?

Intermittent pelvic pain caused by ovarian cysts in adolescence may be due to torsion or partial torsion of the ovary. We present a case of 18-year old adolescent with symptomatic left ovarian torsion with calcifications demonstrated by pelvic MRI and ultrasonography prior to surgery. The pathologic investigation demonstrated dystrophic calcifications. We speculated that the pattern of the intermittent pain in the story of the patient and the dystrophic calcifications in pathologic investigation which is thought that it might have been potentially developed as a result of chronic hypoxia due to intermittent partial torsions over a period of two years.

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

day. To our knowledge, we report the first confirmed case of pediatric synchronous bilateral ovarian torsion in bilaterally normal ovaries and offer a review of the literature. Case: A previously healthy twelve year old female was seen in clinic with a two year history of recurrent right lower quadrant pain with no associated symptoms. Initial ultrasound showed normal ovaries. Repeat imaging ten months later revealed bilateral bulky ovaries: right ovary 43x32x38mm (20cc) and left ovary 56x35x55mm (52.3 cc). Peripheral follicles in keeping with polycystic ovaries were noted. The patient was not yet menarchal. Workup for celiac disease was negative. Shortly following this ultrasound, she presented to the emergency department with a thirty hour history of periumbilical pain associated with nausea and vomiting. On exam, the pain was localized to the left lower quadrant with rebound tenderness. There was absence of leukocytosis. Ultrasound showed a significantly enlarged left ovary (61x45x49mm; 70cc) with diminished flow on Doppler assessment. She underwent laparoscopy with a presumed diagnosis of left ovarian torsion. However, on entering the abdomen, bilateral ovarian torsion of 720o was detected (Figures 1 and 2). Both ovaries were enlarged, left greater than right, without obvious focal lesions. Uteroovarian ligaments were noted to be abnormally long. The ovaries were detorted and pexed to their respective uterosacral ligaments using an intracorporeal technique with nonabsorbable suture.

Ovarian torsion: appearance on MRI

An 8-year-old girl presented with acute intermittent pain in the left abdomen with associated vomiting. US of the abdomen showed a pelvic ovoid mass. The T2-W MRI revealed an enlarged left ovary with multiple peripheral follicles (Fig. 1, short arrows) adjacent to a normal right ovary (Fig. 1, long arrow) consistent with left ovarian torsion. A necrotic ovary with peripheral follicles (Fig. 2, arrows) was removed at surgery.

The Efficacy of Conservative Treatment for Late Term Ovarian Torsion

Recent reports have focused on detorsion after ovarian torsion in the literature. The aim of the study was to investigate late term changes in both ovaries after delayed detorsion following ovarian torsion in rats. Female, prepubertal, Wistar albino rats were divided into four groups (n = 6/group). The left ovaries were used for the study and the right ovaries were kept as the control. The groups were constituted as follows: Group 1: left ovarian fixation, bilateral oophorectomy 48 hours later; Group 2: left ovarian torsion and fixation, bilateral oophorectomy 48 hours later; Group 3: detorsion 48 hours after torsion and bilateral oophorectomy after another 48 hours; Group 4: detorsion 48 hours after torsion and bilateral oophorectomy after 21 days. The total injury score (TIS) was compiled histologically in a double-blind fashion. Congestion, edema, bleeding and polymorphonuclear lymphocyte infiltration were assessed for TIS. The TIS was found to be 8 points in Group 1; 38 in Group 2; 28 in Group 3 and 12 in Group 4, respectively. The TIS was based on results from the left ovaries in Group 1, whereas 31 points were attributable to the left ovaries and 7 to the right ovaries in Group 2. In Groups 3 and 4, TIS points were the same in both study and control ovaries. The difference between the left ovaries of Groups 1 and 2 and the left ovaries of Groups 2 and 4 was statistically significant (p < 0.05). Viable ovarian tissue can be detected even after 48 hours of torsion, which is a relatively long period of ischemia. Tissue injury decreases significantly after detorsion during late recovery. In view of previous case reports in the literature and the present findings, detorsion is recommended in children with ovarian torsion regardless of the ischemic period and/or macroscopic appearance.