妊娠に伴う卵巣過剰刺激症候群で生じた卵巣茎捻転の１症例

抄録

　A 32-year-old woman (gravida 2, para 1) became pregnant after induced ovulation with human menopausal gonadotrophin and artificial insemination. At 5 weeks' gestation, she reported right lower abdominal pain and was diagnosed with ovarian hyperstimulation syndrome and transferred to this hospital. A gestational sac was present in the uterus, and ovarian tumors 11.6 × 5.6 cm on the right and 4.7 × 4.1 cm on the left were noted. The pain gradually decreased with analgesics and rest, and the patient was discharged a week later. Eighteen days later, she was transported by ambulance for right lower abdominal pain and readmitted. A fetus with a size consistent with 8 weeks' gestation and the fetal heart rate were noted. The right ovary, 12.9 × 7.3 cm in size, was located at the top of the uterus, and the region was extremely tender. She had signs of peritoneal irritation, but no increases in white blood cell count or C-reactive protein (CRP) level were noted and the patient was followed up with analgesics during the night. However, the pain was not alleviated by the next morning. Magnetic resonance imaging indicated torsion of the ovarian pedicle, so emergency laparoscopic surgery was performed because the CRP level continued to increase. The right adnexa was twisted about 720° and dark red. Blood flow in the right uterine tube was restored 30 min after untwisting and most of the ovary was necrotic; thus, most of it was removed. Her symptoms quickly disappeared after surgery. There were no signs of threatened abortion after discharge, and the patient gave birth vaginally at 38 weeks' gestation. In this case, the symptoms were conservatively relieved at the time of initial admission. No change in blood data at the time of relapse delayed the surgical intervention. As a result, it became difficult to preserve the affected ovary. To preserve the ovaries by releasing the torsion, if there are physical findings and diagnostic imaging findings suggestive of torsion, it is necessary to use diagnostic laparoscopy regardless of blood test findings and pregnancy duration.