Page 71 - World Journal of Laparoscopic Surgery

CASE REPORT
Rare Case of Ovarian Preserving Surgery in Unmarried

Woman with a Case of U/L Salpingo-oophorectomy

and Its Management: Oophoropexy

1
Sowmya Koteshwara , Deepika Bohra 2

AbstrAct
Ovarian torsion is one of the common gynecological emergency occurring in women during reproductive age. Here, we are presenting a case
of 19-year-old unmarried young girl who came with complaints of pain in abdomen associated with vomiting. She had a history of left-sided
ovarian torsion for which she underwent laparoscopic left salpingo–oophorectomy. She underwent right-sided oophoropexy for recurrent torsion.
Keywords: Adnexal torsion, Oophoropexy, Ovarian torsion, Salpingo-oophorectomy.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1508

IntroductIon
1,2 Department of Obstetrics and Gynecology, JSS Academy of Higher
Ovarian torsion is rotation/twisting of the ovary along its Education and Research Center, Mysuru, Karnataka, India
ligamentous supports causing interrupted blood supply and Corresponding Author: Deepika Bohra, Department of Obstetrics and
sometimes, ischemia and necrosis. Traditionally, ovarian torsion was Gynecology, JSS Academy of Higher Education and Research Center,
managed with salpingo-oophorectomy, mainly because conserving Mysuru, Karnataka, India, Phone: +91 8095713434, e-mail: drdeeps8@
ischemic adnexa was considered a risk factor for thromboembolic gmail.com
sequel. Later, it is known that the risk of embolic events is low and How to cite this article: Koteshwara S, Bohra D. Rare Case of Ovarian
because ischemic adnexa regain follicular activity, recent studies Preserving Surgery in Unmarried Woman with a Case of U/L Salpingo-
advocate conservative treatment of ovarian torsion in pre-pubertal oophorectomy and Its Management: Oophoropexy. World J Lap Surg
1
and young women. Detorsion and oophoropexy is a conservative 2022;15(2):167–169.
surgical approach that should be planned in all young women Source of support: Nil
with ovarian torsion. Oophoropexy for ovarian torsion is easy Conflict of interest: None
procedure and can be done either by suturing ovary to, plication of
ovarian ligament, lateral pelvic wall, or even fixing to the posterior
uterine wall. 2 vascularity, minimal ascites noted, left ovary was not visualized
(postoperative status). The uterus anteverted, normal size, no free
cAse descrIptIon fluid in pouch of Douglas (POD) and was diagnosed with right-sided
ovarian cyst with torsion. The patient was taken for laparoscopy
A 19-year-old unmarried young girl came with complaints of the which showed normal sized uterus, left-side tube and ovary were
lower abdominal pain in the last 1 day, which was progressive in not visualized (postop status), right side tube and ovarian torsion
nature, associated with five episodes of vomiting. noted, congested, necrotic with minimal areas of healthy tissue.
No complaints of dysmenorrhea, white discharge per vagina, Right ovarian detorsion and ovarian plication was done under
burning micturition or increased frequency of micturition, or loose spinal anesthesia.
stools. The girl attained menarche at the age of 15 years; LMP = Post-surgery scan done on day 3 showed right adnexal well-
20 days back. The past cycles were regular, lasting for 3–4 days at defined heteroechoic lesion measuring 6.3 cm × 4.4 cm with
interval of 30 days, moderate flow, associated with mild pain and multiple peripherally arranged follicles and central echogenic
no clots. stroma, minimal peripheral vascularity present, and central
The patient gives similar history in the past and was told to have vascularity in the ovary on color Doppler noted.
left-sided ovarian torsion for which she underwent laparoscopic The patient resumed her normal menstrual cycle after 2 months
left salpingo–oophorectomy 3 years back. On examination, her of the procedure and was followed up for 1 year. The scan was
vitals were stable. There is no pallor, pedal edema. The abdominal repeated after 6 months which showed healthy right ovary and
examination elicited tenderness in right iliac fossa, no ascites, the tube (Figs 1 to 4).
previous surgical scar+, healthy, no organomegaly.
Ultrasound was done and showed right adnexal well-defined
heteroechoic lesion measuring 7.5 cm × 5.7 cm × 5.8 cm with multiple dIscussIon
peripherally arranged follicles and central echogenic stroma, Adnexal torsion is a common condition among gynecological
peripheral vascularity noted on color Doppler, right ovary was not emergencies. The rate of recurrence in postmenarchal women is
visualized separately, adjacent broad ligament showed an increased high mainly due to hyper-mobile or elongated ovarian ligaments,

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