Ovarian Torsion in the Normal Ovary: A Diagnostic Challenge in Emergency Department

Most ovarian torsion (OT) occur in ovaries on taining solid or cystic masses. It is uncommon to find torsion in normal ovary.
Case: A 27 y.o. lady presented to ER at a non O&G hospital, with 1-day history of RIF’s pain. Urine pregnancy and urine dipstick were negative. Abdominal x-raywasnormal. She was treated with fleet enema and the pain improved after defecation. She re-presented the following night at our hospital with similar pain. US revealed an enlarged right ovary with oedematousheterogenouscentral stroma. There was whirlpool sign between uterus and right ovary. A diagnostic laparoscopy was performed. Intraoperative finding srevealedgangrenous right ovary and tube, twisted once. DE torsion of the ovary was performed and ischaemicappearance of ovary improved. Post operati recovery was uneventful.
Discussion: Diagnosis of OT is challenging in the absence of adnexal mass and negative imaging studies because it can mimic other acute abdominal conditions. CT or MRI could be used to detect torsion. US remains the mostfeasibleinitialdiagnosticmodalitybecauseitisreadilyaccessible and can differentiatecysticovarianpathologywithoutradiation.
Conclusions: Should be considered in any female patient with acute lower abdominalpaineven with normal appearance of ovary. In the context of high clinical suspicion of torsion, the absence of suspicious imaging findingsdoesnotexclude the diagnosisunlessanother cause for the patient’ssymptomsisidentified.


Julia Tan

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