Adnexal Torsion of Normal Adnexa at 19 Weeks of Gestation: A Case Report

Adnexal torsion is a common gynecologic emergency but is relatively rare during pregnancy, with most cases occurring in the first trimester. Torsion of a normal adnexa without an underlying mass is uncommon, and torsion arising in the second trimester is far less common.

A 32-year-old pregnant woman (gravida 5, para 0) with a history of left salpingectomy for ectopic pregnancy and laparoscopic left ovarian cystectomy for a benign cyst presented with acute right lower quadrant pain at 19 weeks and 1 day of gestation. Emergency computed tomography (CT) revealed a heterogeneous hyperdense lesion in the right adnexa with possible hemorrhage; torsion could not be excluded. Emergency single-port laparoscopic exploration was performed, which revealed multiple twists of the right ovarian proper ligament and the infundibulopelvic ligament (IP ligament). The right ovary and fallopian tube appeared black-purple and necrotic, while the appendix was grossly normal. Accordingly, right adnexectomy was performed. Postoperative pathology confirmed extensive hemorrhagic necrosis of the fallopian tube and ovarian tissue, consistent with torsion. The pregnancy continued uneventfully, and follow-up during the third trimester showed normal fetal development.

This case indicates that torsion of normal adnexa can occur in the second trimester, and adhesions from prior pelvic surgery may be a predisposing factor. For pregnant patients with acute abdominal pain and a history of pelvic surgery, a high index of suspicion for adnexal torsion is warranted.