A Nulliparous Intraoperative Case of Adnexal Torsion

A 27-year-old nulliparous woman experienced sudden, colicky lower abdominal pain lasting for 30 minutes. Her pain radiated to the back and was accompanied by four episodes of vomiting.

The lady had a regular menstrual history. On examination, she had tenderness in the left iliac fossa.

The final diagnosis was adnexal torsion in a nulliparous individual – prompting subsequent surgery for left ovarian torsion.

The surgical procedure involved laparoscopic left salpingectomy, detorsion of the left ovary, and fixation. Clinical suspicion played a crucial role in the timely diagnosis of adnexal torsion, preventing potential morbidity. Ultrasound with Doppler proved valuable in identifying adnexal mass with torsion. For women in the reproductive age group, conservative surgery is the preferred treatment method to preserve menstrual function.

Diagnosing adnexal torsion poses a challenge, and the likelihood of surgery depends on clinical suspicion. Laparoscopy is the preferred approach, and detorsion is deemed safe. This case emphasizes the complexity of accurate adnexal torsion diagnosis, highlighting the importance of recognizing it as a surgical emergency. Early intervention through laparoscopy or laparotomy is crucial, especially when considering fertility preservation.

Source: Mohapatra K, Sultana NN, Behuria S, Sahoo D, Singh M. The Journal of Obstetrics and Gynecology of India. 2024 Jan 21:1-6.