Tubo-ovarian torsion

Case contributed by Mr. Dennis Odhiambo Agolah

Presentation

One day of severe abdominal pain with vomitus, to rule out right ovarian torsion or appendicitis.

Patient Data

Age: 25 years
Gender: Female
Ultrasound

Globularly unilaterally enlarged right ovary (measuring 41.14 cc in volume) with heteroechogenic parenchymal distortion and countable peripherally sitting sub-centimeter follicles is noted. On color and power Doppler evaluation, there is no parenchymal flow signal within the right ovary. A large, septated and walled-off, predominantly fluid-filled and anechoic structure parades ipsilaterally within the right adnexa supero-medially and continues with the right oviduct (which appeared as an organized hematoma during imaging, but later got confirmed as a para-ovarian cystic lesion). Subtle clear fluids of centimetric depths is seen within the Douglas Pouch and within the Morrison's pouch.

The left ovary: Normal both in parenchymal echopattern and follicular pattern and demonstrating unremarkable spectral flows with its intra-ovarian systolic velocity at 16.1 cm/s and a resistive index of 0.49 plus a pulsatility index of 0.64, noted is normal.

Pathology

Specimen: Gross pathology of the torsed right ovary.

POST OPERATIVE FINDING:

Large ovarian cyst fused to the fallopian tube, all twisted and necrosed. Right salpingoophorectomy performed.

Case Discussion

Trans-abdominal ultrasound features reflecting torsed right sided ovary confirmed post-operatively. No sonographic or surgical features of an inflamed appendix was seen.  A twisted vascular pedicle was visualized conspicuously supero-laterally towards the right ovarian peripheral aspect on power Doppler mapping.

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