A Unique Case of Adnexal Torsion

Abstract Background: A case of adnexal torsion resulting in ischemic changes without complete interruption of blood flow is described. Case: The patient had history of infertility, right unicornuate uterus, and endometriosis. She conceived with twins after in vitro fertilization and embryo transfer. At 10 weeks of gestation she presented with acute abdomen in the presence of normal transvaginal ultrasound Doppler flow study. Both ovaries were enlarged, with multiple corpora lutea cysts as a result of controlled ovarian stimulation and the effect of human chorionic gonadotropin on the ovaries during pregnancy. At laparoscopy, right adnexal torsion with two twists was documented in the absence of any change in color of the adnexa. Laparoscopic untwisting of the right adnexa was performed successfully, and the patient had an uneventful recovery and subsequently delivered at 32 weeks of gestation. Conclusions: A normal Doppler flow cannot rule out adnexal torsion. Diagnostic laparoscopy is the gold standard for the diagnosis and management of adnexal torsion. (J GYNECOL SURG 28:359)