Recurrent adnexal torsion in a woman with polycystic ovaries: A case report

Abstract

　Pedicle torsion of the ovaries is more commonly seen in children but is rare in menstruating women. We present a case of recurrent non-neoplastic adnexal torsion in a reproductive-age woman. An 18-year-old woman experienced sudden abdominal pain and was admitted to our emergency department. Magnetic resonance imaging revealed that her left ovary was swollen to 60 mm and had become twisted, and that several small cysts were present beneath the ovarian capsule; however, no malignancy was detected. The blood supply to the left ovary was still intact, and the patient was discharged after 1 day upon symptom improvement.

　After 4 years, the patient was referred to our department due to rapidly worsening left lower quadrant pain. Transvaginal ultrasonography showed an enlarged stroma of the left ovary with multiple small cysts under the ovarian capsule. Computed tomography revealed that the left ovary was swollen to 48 mm and twisted with a weak enhancement effect, while the right ovary was polycystic. The patient underwent emergency laparoscopic detorsion, and her postoperative course was uneventful. Oral low-dose combined estrogen-progestin was used to alleviate dysmenorrhea symptoms. A follow-up at 12 months postoperatively revealed bilateral polycystic ovaries, but no abdominal symptoms. However, after 18 days, she visited the emergency department again with persistent abdominal pain. The diagnosis of left adnexal torsion and massive ovarian edema was confirmed, as in the previous case. She underwent laparoscopic detorsion and left ovarian fixation. Non-neoplastic adnexal torsion is mostly recurrent; hence, careful follow-up is important even after detorsion.