EC Gynaecology

Ovarian torsion accounts to 1 - 6% of surgical treatment for adnexal masses. Its incidence rises during pregnancy, but is a rare event. There are varied predisposing factors, however, etiology remains unknown. Epidemiologically, torsion occurs commonly in the 2^nd trimester of pregnancy. We are reporting four cases of ovarian torsion in pregnancy, suspected clinically and confirmed by ultrasound. 4 different treatment modalities were used, namely ovarian cystectomy for case 1, oophoro-pexy in case 2, oophorectomy for case 3 and laparoscopic cystectomy for case 4. Three out of the four cases occurred in the 1^st trimester of pregnancy, out of which two patients had history of untreated ovarian mass prior to conception. Ovarian torsion is an urgent gynecological condition that needs prompt intervention during pregnancy. Modalities like laparotomy, laparoscopy or conservative management with detorsion can be the treatment of choice. However, if predisposing factors are caught in pre-conceptional period, risk of torsion in pregnancy may be reduced.

Keywords: Acute Abdomen; Ovarian Torsion; Oophoro-Pexy; Cystectomy; Oophorectomy

1. Hua Dingchao., et al. “Torsion of Ovarian Endometrioma in Pregnancy: A Case Report and Review of the Literature”. Tropical Doctor3 (2019): 221-223.
2. Senarath Sachintha., et al. “Ovarian cysts in pregnancy: a narrative review”. Journal of Obstetrics and Gynaecology: The Journal of the Institute of Obstetrics and Gynaecology2 (2021): 169-175.
3. Nasiri A., et al. “Ovarian Torsion in Pregnancy: A Case Report”. Case Reports in Obstetrics and Gynecology 3 (2017): 2.
4. Asfour V., et al. “Clinical risk factors for ovarian torsion”. Journal of Obstetrics and Gynaecology: The Journal of the Institute of Obstetrics and Gynaecology 35.7 (2015): 721-725.
5. Lourenco Ana P., et al. “Ovarian and tubal torsion: imaging findings on US, CT, and MRI”. Emergency Radiology2 (2014): 179-187.
6. Oltmann SC., et al. “Cannot exclude torsion--a 15-year review”. Journal of Pediatric Surgery 6 (2009): 1212-1217.
7. Poonai N., et al. “Pediatric ovarian torsion: case series and review of the literature”. Canadian Journal of Surgery 2 (2013): 103-108.
8. D'Ambrosio V., et al. “Adnexal masses in pregnancy: an updated review on diagnosis and treatment”. Tumori Journal (2020): 300891620909144.
9. Huang Ci., et al. “A review of ovary torsion”. Ci Ji Yi Xue Za Zhi = Tzu-Chi Medical Journal3 (2017): 143-147.
10. Houry D and Abbott JT. “Ovarian torsion: A fifteen‑year review”. Annals of Emergency Medicine 38 (2001): 156-159.
11. Yen CF., et al. “Risk analysis of torsion and malignancy for adnexal mases during pregnancy”. Fertility and Sterility 91 (2009): 1895-1902.
12. Johnson TR Jr and Woodruff JD. “Surgical emergencies of the uterine adnexae during pregnancy”. International Journal of Gynecology and Obstetrics 24 (1986): 331‑33
13. Boswell Kathleen Marie Osterman and Kaylen Mark Silverberg. “Recurrence of ovarian torsion in a multiple pregnancy: conservative management via transabdominal ultrasound-guided ovarian cyst aspiration”. Fertility and Sterility5 (2010): 1910.e1-3.
14. Weitzman Vanessa N., et al. “Prevention of recurrent adnexal torsion”. Fertility and Sterility5 (2008): 2018.e1-3.
15. Pansky M., et al. “Torsion of normal adnexa in postmenarchal women and risk of recurrence”. Obstetrics and Gynecology 109 (2007): 355-359.
16. Functional ovarian cysts and oral contraceptives. negative association confirmed surgically. A cooperative study”. The Journal of the American Medical Association 228 (1974): 68‑6
17. Caillouette JC and Koehler AL. “Phasic contraceptive pills and functional ovarian cysts”. American Journal of Obstetrics and Gynecology 156 (1987): 1538‑15
18. Grimes DA., et al. “Ovulation and follicular development associated with three low-dose oral contraceptives: A randomized controlled trial”. Obstetrics and Gynecology 83 (1994): 29‑
19. Mishell DR Jr. “Noncontraceptive benefits of oral contraceptives”. The Journal of Reproductive Medicine 12 (1993): 1021S-1029S.
20. Kaleli B., et al. “Reperfusion injury after detorsion of unilateral ovarian torsion in rabbits”. European Journal of Obstetrics and Gynecology and Reproductive Biology110 (2003): 99-101.
21. Dolgin SE. “Acute ovarian torsion in children”. The American Journal of Surgery 183 (2002): 95-96.