Adnexal torsion in the first trimester of pregnancy: diagnosis, laparoscopic management, and review of the literature

Abstract

We report a case of an adnexal torsion in a 27-year-old woman in her 12th week of gestation. She presented with hypogastric and lumbar pain with biliary vomiting and nausea. Upon physical examination, tenderness in the right lower quadrant with rebound tenderness was apparent, and gynecological examination revealed right adnexal tenderness with absence of abnormal cervical discharge. The transvaginal ultrasonography demonstrated an enlarged cystic right ovary with no flow detected on color and power Doppler mode. We performed a laparoscopy and the diagnosis of adnexal torsion was confirmed. Detorsion of the right adnexa and cystectomy of the ovary was achieved without surgical or anesthetic complications. The patient was supplemented with progesterone during pregnancy and gave birth to a healthy child at term. Adnexal torsion is an unusual cause of abdominal pain in gestation with an incidence of 1-5:10.000, and it is more often observed during the first and early second trimesters of gestation. The clinical signs are often unspecific, and an ultrasound is the most commonly used imaging method for this diagnosis. The laparoscopy is the preferred method of diagnosis and treatment can be safely used in pregnancy if the guidelines are respected.