Title: Adnexal Torsion with Pregnancy: A Case Presentation
Authors: Monika Thakur, Lalit Mahajan, Hemender Mahajan, Anshul Chamail
DOI: https://dx.doi.org/10.18535/jmscr/v7i11.144
Abstract
A 24-year-old women, presented with complaints of acute onset lower abdominal pain and vomiting. On clinical examination, a tender mass in the hypogastric region was palpable. Pelvic examination revealed the same mass felt anterior and through the right fornix, along with cervical motion tenderness. She missed her last periods and urine pregnancy test was weakly positive. Laboratory examination included a β-hCG assay with results of 39.8, haemoglobin level of 10.7, and white blood cell count of 9600. Ultrasonography revealed a cystic mass of size 9.9 × 8.5 cm in the right adnexa along with presence of heterogenous area of 5 × 8.2 cm with no vascularity with surrounding free fluid. A provisional diagnosis of chronic ectopic versus ovarian torsion was made as ultrasonographic findings were inconclusive of torsion. Exploratory laparotomy was done which revealed an enlarged, cyanotic and congested fallopian tube along with completely necrotic ovary on right side. Right salpingoopherectomy was performed because after untwisting of vascular pedicle there were no signs of reperfusion. The patient was discharged uneventfully on the fifth postoperative day. This case describes an interesting case of adnexal torsion along with pregnancy which was being misdiagnosed as chronic ectopic because of her positive urine pregnancy test and indeterminate ultrasound findings.
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