P13.22: Conservative sonographic‐based management of bilateral asynchronous adnexal torsion with laparoscopic detorsion and sparing of twisted ischemic adnexa: a case report

A 36-year-old woman presented with 96 hours of intermittent abdominal right lower quadrant pain, nausea, and episodes of vomiting. Transvaginal sonography (TVS) showed an inhomogeneous enlarged right ovary (8 × 7 × 5 cm), painful at push-and-pull manoeveours. At power-Doppler (PD) imaging, arterial blood flow but no venous blood flow was detectable. An ovarian edema secondary to adnexal torsion was diagnosed. At laparoscopy, the sonographic diagnosis of right adnexal torsion was confirmed. Detorsion without removal of the adnexa was performed. The bluish appearance of the adnexa disappeared in 12minutes. The patient was discharged on day 2. A six months therapy with oral contraceptive was prescribed. A normal ovarian function was confirmed after estro-progestin therapy. Ten months after this episode, the patient presented again after 72 hours of intermittent abdominal left lower quadrant pain, very close to the previous one. At TVS, an inhomogeneous enlarged left ovary (6 × 6 × 5 cm), with follicles and a solid corpus luteum was observed. Venous and arterial blood flows at PD were observed. Adnexal torsion of the controlater adnexa was diagnosed at TVS and confirmed at laparoscopy. Elongated utero-ovarian ligaments were found, and the patient was treated with laparoscopic shortening of the utero-ovarian ligament by bipolar coagulation. No postoperative complications occurred. Hospital stay was 2 days. Sonographic follow-up evidenced normal ovaries. The patient has remained symptom-free for a six months follow-up. Gray-scale sonographic examination and Power Doppler flow assessment can be useful both for diagnosis of torsion and for its follow up. Conservative laparoscopic surgery of twisted adnexa should be recommended to preserve ovarian function. Laparoscopic shortening of the utero-ovarian ligament to prevent recurrent torsion may be a reasonable alternative to oophoropexy as prophylaxis for ovarian torsion.