Three cases of ovarian torsion after laparoscopic hysterectomy

Abstract

　Total laparoscopic hysterectomy (TLH) carries a higher risk of ovarian torsion compared to abdominal or vaginal hysterectomy. We present three cases of ovarian torsion following TLH necessitating surgical intervention.

Case 1: A 50-year-old woman experienced abdominal pain 17 months post-TLH with bilateral oophorectomy for uterine fibroids. A 4.8-cm left ovarian cyst was discovered on CT scan, prompting emergency laparoscopic surgery. The cyst was torsed and necrotic, leading to left adnexectomy.

Case 2: A 50-year-old woman presented with persistent abdominal pain 11 months post-TLH with bilateral oophorectomy for fibroids. Contrast-enhanced CT scan revealed a 4.5-cm non-enhancing pelvic mass and hemorrhagic ascites, prompting emergency laparoscopic surgery. Right ovarian torsion and hemorrhagic necrosis necessitated right adnexectomy.

Case 3: A 44-year-old woman complained of abdominal pain 7 months post-TLH with bilateral oophorectomy for fibroids. Contrast-enhanced CT scan revealed a 6-cm pelvic mass, suspected to be a hematoma, prompting emergency laparoscopic surgery. Hemorrhagic cyst and left ovarian torsion led to left adnexectomy. TLH-related ovarian torsion is attributed to fewer adhesions, less ovarian damage, preservation of ovarian function, and incision of the posterior ligament, enhancing ovarian mobility. The risk of ovarian torsion after TLH is higher compared to abdominal and vaginal total hysterectomies, necessitating consideration of ovarian torsion in cases of acute abdomen with a history of TLH. As a preventive measure, ovarian fixation may be useful, and further investigation into its effectiveness will be necessary as more cases are accumulated.