| Author: Eva Račanská
Description:
32 year old primipara arrives to the emergency for a sudden onset of a pelvic pain more on the left side. She felt some relief after spasmoanalgetics but than it got worse again and was accompanied by nausea and vomiting. Patient delivered vaginally 3 months ago and is breastfeeding, had no menstrual period after delivery. Urology and surgical examination was negative. She is afebrile, laboratory results showed mild leucocytosis, CRP 10.4. Bimanual pelvic examination: uterus and cervix tender to palpation, behind the uterus more on the left round formation 60 mm in diameter which is tender to palpation. The ultrasound examination: anteverted uterus of normal size, endometrium 7 mm, right ovary of normal size, shape and echogenity. Left ovary is not visible, large, oblong anechogenic formation 60 by 90 mm in size behind the uterus, edging cranially, reminding dermoidal cyst. Moderate amount of free fluid in the Pouch of Douglas. Diagnose of dermoidal cyst with possible adnexal torsion was built and diagnostic laparoscopy was performed. Uterus and right ovary of normal size and shape. Left ovary and uterine tube were 3 times torquated, ovary was enlarged - 80 mm in diameter, livid, haemorrhagic, left uterine tube was livid, edematous, thick as a finger. Left ovary was detorquated into a proper position and left in place, haemorrhagic cysts were drained and coagulated. Patient came for the check-up a 6 weeks after surgery, she had no problems, left ovary was still enlarged 80 by 50 mm, ultrasound image suggested dermoidal cyst, second-look laparoscopy is considered.
Categorization:
Adnexal Torsion
Attachments:
Description: Uterus and large livid mass filling the pelvic cavity.
Description: Uterus and right uterine tube of normal appearance, visible trosion of the left uterine tube.
Description: Uterus and torquated left ovary and uterine tube.
