正常卵巣茎捻転の診断に卵巣流入血管抵抗値が参考となった一例

抄録

  Torsion of normal adnexa is rare. Most patients present with nonspecific symptoms, and diagnosis is challenging; however, urgent treatment is essential for ovarian tissue preservation. We describe a patient in whom the intra-ovarian vascular resistance (RI) was used to diagnose adnexal torsion and facilitated prompt laparoscopic ovarian fixation.

  A 20-year-old woman was referred to our department with acute left-sided lower abdominal pain. Transvaginal ultrasonography revealed a mildly enlarged left ovary with torsion around its pedicle. On pulsed Doppler evaluation, the ovarian RI was as high as 0.94, and a notch at an early stage of dilatation was identified. Owing to persistent pain, we performed laparoscopy, which revealed torsion of the left adnexa around the ovarian ligament. We released the torsion because the left ovary was not necrotic.

  The left ovarian ligament was longer than the right; therefore, we fixed the ovary to the retroperitoneum to avoid the risk of recurrence. At the time of discharge, the ovarian RI decreased to 0.66, and the notch observed at an early stage of dilatation had disappeared.

  Ultrasonography, particularly pulsed Doppler evaluation, offers high diagnostic accuracy and is a common imaging modality used in clinical practice in recent years. We diagnosed this patient based on the high ovarian RI observed in this case. Clinicians should consider torsion of normal adnexa in the differential diagnosis in young women with abdominal pain of unknown etiology. The ovarian RI is a useful indicator to diagnose this condition.