Ovarian torsion (OT) is a rare cause of acute abdominal pain during puerperium.
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The diagnosis of OT during puerperium is difficult, and occasionally remains a diagnostic dilemma.
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The clinical and laboratory findings are variable and nonspecific.
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Early use of bedside abdominal ultrasonography is important in differential diagnosis of OT from other acute abdominal pathologies.
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A heightened awareness of the relevant risk factors, the clinical presentation, and a high degree of clinical suspicion are essential for early and accurate diagnosis of OT.
Abstract
INTRODUCTION
Ovarian torsion (OT) is a rare cause of acute abdominal pain that requires prompt recognition and treatment during puerperium. Diagnosis of OT can be challenging due to nonspecific clinical features and uncommon objective findings. The management of OT is often delayed because of diagnostic uncertainty. Early and timely recognition and prompt intervention are crucial to preserve ovarian function and to minimize morbidity.
PRESENTATION OF CASE
We report a 29-year-old postpartum woman who presented to the emergency department (ED) with severe right flank pain, nausea and anorexia initially considered as renal colic. After further investigation, OT caused by large mucinous cyst was diagnosed. Right-sided salpingo-oophorectomy was performed due to hemorrhagic ovary and huge cystic mass causing ischemic OT.
DISCUSSION
OT is often diagnosed based on the clinical presentation, including severe, sharp, sudden onset of unilateral lower abdominal pain and tenderness with a palpable laterouterine pelvic mass and nausea/vomiting. Emergency surgical intervention should be performed if OT is suspected to confirm the diagnosis and uncoil the twist to prevent ovarian damage.
CONCLUSION
In conclusion, emergency physicians should be aware of the possibility of OT in postpartum women. Therefore, early and timely surgical intervention should be undertaken.
