Sildenafil Citrate: Novel Therapy in the Management of Ovarian Torsion

Ovarian torsion is defined as partial or complete rotation of ovarian vascular pedicle, leading to the obstruction of venous outflow and arterial inflow. It is an emergency condition with an incidence of 2%-15% in patients with adnexal masses. The main risk in ovarian torsion is an ovarian mass or an enlarged ovary with a long pedicle. Due to the rotation of ovarian tissue axis on its vascular pedicle, there is compression of vessels followed by stromal edema, hemorrhagic infarction, and necrosis of adnexa. Expedient diagnosis poses a difficult challenge because clinical presentation is a variable and often misleading. We report a case of right ovarian torsion after oocyte retrieval for in vitro fertilization, where vaginal sildenafil citrate was successfully used to reduce ovarian edema by improving venous drainage. It also helped in maintaining ovarian tissue perfusion and preventing reperfusion injury and spontaneous detorsion of the ovary without any surgical intervention.