Conservative management of twisted ischemic adnexa in early pregnancy

Diagnosis of adnexal torsion can be difficult, especially during pregnancy. Delay in diagnosis can lead to necrosis and loss of the affected ovary compromising the reproductive capacity, especially in young women. A 22-year-old primigravida presented to the emergency room at 10 weeks of gestation with acute onset left iliac fossa pain. Ultrasound examination showed a live intra-uterine gestation of 10 weeks, enlarged and edematous left ovary with a clear cyst of 76 mm × 63 mm with flow to the ovary. She underwent emergency surgery with a provisional diagnosis of torsion of left adnexa. Mini-laparotomy, detorsion of the twisted adnexa and ovarian cystectomy with reconstruction was performed thus conserving the tube and ovary. The pregnancy progressed normally; follow-up ultrasound scans showed normal functioning ovaries. Clinical appearance of torted adnexa does not correlate well with the residual function. Ovarian function can be preserved by untwisting, even if ovary appears necrotic.