Abstract
Objective: To report successful release of ovarian torsion in two cases of ovarian hyperstimulation syndrome (OHSS) by laparoscopic surgery.
Case 1: A 28-year-old woman (gravida 1, para 0) with a second pregnancy confirmed 3 days before presentation was transported to our hospital by the ambulance because of the sudden onset of severe abdominal pain. Her medical history included a first pregnancy terminated by spontaneous abortion, a diagnosis of polycystic ovary syndrome (PCOS) at a nearby hospital, and clomiphene citrate administration to stimulate ovulation. On examination, her right ovary was enlarged and accompanied with ascites. We made a diagnosis of OHSS and suspected ovarian torsion because of the uncontrollable pain. Diagnostic laparoscopy confirmed ovarian torsion; thus, we released the ovary. She achieved spontaneous labor at 40th week of gestation and delivered a healthy 3350-g baby girl.
Case 2: A 31-year-old woman (gravida 0) diagnosed with PCOS and right-side salpingemphraxis at a nearby clinic, who was planned for in vitro fertilization following a short protocol to induce ovarian stimulation, experienced abdominal distension and consulted us 5 days after egg retrieval. Upon admission to our hospital, we detected enlarged ovaries and ascites and made a diagnosis of OHSS. Because she complained of severe abdominal pain the next day, we suspected ovarian torsion and released the right ovary by laparoscopic surgery.
Conclusions: Ovarian torsion should be detorsioned as soon as possible to preserve ovarian function and reduce the risk of complications. For patients presenting with abrupt abdominal pain, OHSS should be considered and diagnostic laparoscopy should be performed without delay. Furthermore, for such cases before 9 weeks of gestation, luteal supplementation is a valid treatment option.
