Postmenopausal Ovarian Torsion Mimicking an Abdominopelvic Mass: A Case Report

A report describes a case of a 73-year-old woman, parity 5 with five live issues, who presented to the gynecology emergency with severe continuous abdominal pain for four hours, associated with one episode of vomiting. She was postmenopausal for 20 years and had no significant past medical or surgical history. She was uncomfortable and restless on examination, with a pulse rate of 118 bpm, blood pressure 130/90 mmHg, respiratory rate 22 bpm, and oxygen saturation 99%. A 28-30 week-sized, tender abdominopelvic mass of mixed consistency was palpated on abdominal and vaginal examination, while the rectal mucosa was free.

Laboratory investigations showed hemoglobin 12.7 gm/dL, total leucocyte count 7.56 × 10³, and normal liver and kidney function tests. Cancer antigen-125 was 26 IU/L. Ultrasonography revealed a large right anechoic cystic lesion measuring 20.79 × 17.41 × 16.79 cm (volume 3,181 mL) in the right adnexa extending into the abdomen. The cyst had thin walls around the upper pole and absent vascular flow on colour doppler, suggesting ovarian torsion.

An emergency exploratory laparotomy was done via a midline vertical incision. Peritoneal fluid was sent for cytology. Intraoperatively, a right ovarian cyst measuring 20 × 15 cm, filled with hemorrhagic fluid, was found twisted four times around the infundibulopelvic ligament in the abdominal cavity. The mass was untwisted and excised with clamps applied to the infundibulopelvic ligament. Frozen section was not available, but the cut surface showed thick papillary projections, prompting a total abdominal hysterectomy with bilateral salpingo-oophorectomy. The abdomen was inspected, and no suspicious deposits were found. It was found that the peritoneal fluid did not have malignant cells.

Histopathology confirmed a serous cystadenoma of the ovary. The patient was discharged on the 10th day following surgery, and the postoperative course was uneventful.

Reference:

Marwaha PD, Kaundal A, Malik N, Kaushal S. Ovarian torsion in a postmenopausal woman: a case report and review of literature. Journal of Menopausal Medicine. 2023 Nov 28;29(3):134.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10796202/