Ovarian hyperstimulation syndrome with a twist: a rare case of adnexal torsion complicating severe ovarian hyperstimulation syndrome

Zufishan L. Amin, Apratim Shambharkar, Amarjeet Bava, Swati Gawai, Zubin Vicky Driver
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2026 · vol. 15(3) , pp. 1130–1132 · doi:10.18203/2320-1770.ijrcog20260585 · W7131427574
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Abstract

Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovarian stimulation protocol. This rare case highlights a patient with severe OHSS complicated by adnexaltorsion. A 24-year-old married woman with history of oocyte donation presented in tertiary care centre with complaints of progressive abdominal pain, distension and shortness of breath. Clinical examination and investigations confirmed diagnosis of severe OHSS and right sided enlarged ovary (1190 cc) with torsion. Emergency laparotomy with right salpingo-oophorectomy was done. Adnexal torsion is common due to ovarian enlargement is common amongst patients undergoing ovulation induction. Doppler ultrasound aids the diagnosis, and surgical intervention is warranted. Early recognition of patient at risk of OHSS is essential for its prevention. Surgical management of adnexal torsion in OHSS is crucial to avoid complications.
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Ovarian hyperstimulation syndrome with a twist: a rare case of adnexal torsion complicating severe ovarian hyperstimulation syndrome DOI: https://doi.org/10.18203/2320-1770.ijrcog20260585Keywords: Adnexal torsion, Ovarian hyperstimulation syndrome, Enlarged ovaries, Emergency laparotomyAbstract Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovarian stimulation protocol. This rare case highlights a patient with severe OHSS complicated by adnexaltorsion. A 24-year-old married woman with history of oocyte donation presented in tertiary care centre with complaints of progressive abdominal pain, distension and shortness of breath. Clinical examination and investigations confirmed diagnosis of severe OHSS and right sided enlarged ovary (1190 cc) with torsion. Emergency laparotomy with right salpingo-oophorectomy was done. Adnexal torsion is common due to ovarian enlargement is common amongst patients undergoing ovulation induction. Doppler ultrasound aids the diagnosis, and surgical intervention is warranted. Early recognition of patient at risk of OHSS is essential for its prevention. Surgical management of adnexal torsion in OHSS is crucial to avoid complications. Metrics References Lakshmana V.A case report on ovarian torsion after ovarian stimulation. Int J Reprod Contracept Obstet Gynecol 2025;14:2006-8. DOI: https://doi.org/10.18203/2320-1770.ijrcog20251603 Practice Committee of the American Society for Reproductive Medicine. Electronic address: [email protected]. Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertil Steril. 2024;121(2):230-45. Higashide R, Tsukada T, Ichikawa M, Sakamoto M, Shimabukuro K. Ovarian torsion due to ovarian hyperstimulation syndrome diagnosed by sonographic whirlpool sign in the first trimester of pregnancy: A case report. Radiology Case Rep. 2023;18(10):3386-9. DOI: https://doi.org/10.1016/j.radcr.2023.07.012 Mandelbaum R, Matsuo K, Awadalla M, Shoupe D, Chung K. Risk of ovarian torsion in patients with ovarian hyperstimulation syndrome. Fertil Steril. 2019;111(4):e50-1. DOI: https://doi.org/10.1016/j.fertnstert.2019.02.116

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