Bilateral ovarian torsion with ovarian fusion in the setting
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Polycystic ovarian syndrome is a risk factor for ovarian torsion because the ovaries are enlarged and heavy.

De-torsion with adnexal conservation is favored over removal of the adnexa because of its high rate of functional preservation. Oophoropexy should be considered for the prevention of recurrence of torsion when there is no removable ovarian pathology.

Adnexal torsion is a gynecologic emergency due to the risk of ovarian necrosis associated with delayed diagnosis and treatment. Torsion is responsible for 2.7% of all gynecologic emergencies. There is often association with benign ovarian masses, especially those >5 cm; however, enlargement of the ovary for any reason can increase the risk of torsion. Specifically, large heavy cysts, such as those seen in polycystic ovarian syndrome (PCOS) and following ovarian stimulation, are known risks for torsion.

A 25-year-old woman had a delayed diagnosis of adnexal torsion due to polycystic ovaries despite typical presentation and imaging. A unique finding was ovarian fusion; separation was required in order to resolve the torsion. Oophoropexy was performed to prevent the recurrence of torsion.

Conclusively, Ovarian torsion should be suspected in the setting of abdominal pain, enlarged polycystic ovaries, and absent adnexal blood flow on ultrasound. This case demonstrates the resilience of the adnexa and the highly variable time to necrosis in the setting of torsion.

Dr. V●●●●●●j D●●●i
Dr. V●●●●●●j D●●●i Legal Medicine
Detorsion !!! Discernment and wise use of discretion needed for it; isn' t it? May be justifiable in cases of minimal torsion without any serious vascular impediment.
Mar 4, 2020Like