A case of adnexa torsion of a normal ovary at 34 weeks of gestation, and laparoscopic salpingo-oophorectomy was performed

Abstract

　Adnexal torsion of normal sized ovary during pregnancy is rare, and the cause of its onset is not clear. Here, we report a case of a patient who developed torsion of a normal ovary at 34 weeks of gestation and underwent laparoscopic salpingo-oophorectomy.

　A 25-year-old pregnant woman (gravida 2, para 1) attended hospital at 34 weeks of gestation with acute left lower abdominal pain. Transabdominal ultrasonography revealed normal size left ovary (40×20 mm), which was with strong tenderness. Adnexal torsion of the left normal ovary was suspected and laparoscopic surgery was performed. Surgery was performed under general anesthesia with the patient in the supine position. Intraoperatively, a 12-mm umbilical port was initially inserted with open access technique, and two 5-mm trocars were inserted through the left abdomen near the left ovary. A 10-mm, 30-degree scope was used, and the pneumoperitoneum pressure was 10 mmHg. The scope was inserted along the abdominal wall, avoiding the pregnant uterus. The left ovary was twisted 360 degrees. The torsion was released and salpingo-oophorectomy was performed. Histopathological examination of the left ovary revealed mild congestion and hemorrhage in the ovarian stroma, and dilated veins, but no tumorous lesions were found. There were no problems during the operation, and the operation time was 28 min; the blood loss was minimal. The course of her pregnancy was uneventful, and she had a normal vaginal delivery at 40 weeks of gestation.

　It is necessary to recognize that one of the causes of acute abdomen in late pregnancy is adnexa torsion of the normal ovary. Laparoscopic surgery is an option for the treatment of torsion; however, it is necessary to consider the surgical position, port position, and scope according to the physical and physiological changes in late pregnancy.