Download PDF
CC BY 4.0 · Avicenna J Med 2024; 14(04): 223-227
DOI: 10.1055/s-0045-1801841
Case Report

Adnexal Incarceration in a Posterior Pelvic Peritoneal Defect Associated with Ovarian Torsion: A Case Report

Lina Qattea
1   Department of Obstetrics and Gynecology, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
,
Wafa Alshahrani 
1   Department of Obstetrics and Gynecology, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
,
Samaher Samer Alouch
2   College of Medicine at Al Faisal University, Riyadh, Saudi Arabia
,
Abdulrazzaq Qattea
2   College of Medicine at Al Faisal University, Riyadh, Saudi Arabia
,
Wafaa Qatteh
2   College of Medicine at Al Faisal University, Riyadh, Saudi Arabia
,
Sami Qattea
2   College of Medicine at Al Faisal University, Riyadh, Saudi Arabia
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Ovarian torsion is one of the gynecological emergencies and surgical intervention is the standard management for ovarian salvage as well as reveals some unexpected anatomical defects that increase the risk of ovarian torsion. We report a case of a 27-year-old single, nulliparous female taken for diagnostic laparoscopy with suspicion of ovarian torsion. Intraoperatively, we found right adnexa torsion (ovary with tube) along with incarceration of the right ovary and tube into the big peritoneal sac, which was located medial to the right uterosacral ligament. Detorsion and careful pulling of the swollen adnexa were done to the outside of the big peritoneal sac using nontraumatic laparoscopic forceps. The left side was normal with normal left adnexa. The patient had a second laparoscopic look with a plan for peritoneal closure of the big peritoneal defect.

There are two cases which have previously reported ovarian incarceration, but were not associated with ovarian torsion, and did not involve peritoneal closure unlike our report of ovarian detorsion and peritoneal defect closure. The etiology of this condition is thought to be likely congenital as there were no other visible etiologies like pelvic trauma, previous surgery, pelvic inflammatory disease, or endometriosis.

Our clinical assessment suggests that a peritoneal sac can enhance the course of ovarian torsion to involve ischemic changes of the ovary when trapped inside of it, by its prevention of spontaneous detorsion. This condition will result in the compression of the cells between the sac wall and subsequent tissue edema enhancing the ischemic effect.

Keywords

ovarian torsion - pelvic pain - peritoneal defect - surgery

Informed Consent

Not needed.


Data Availability

Any inquiries regarding supporting data availability of this study should be directed to the corresponding author.




Publication History

Article published online:
11 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Kataoka K, Egami R, Izumi Y. et al. Laparoscopic treatment of acute ovarian incarceration into the pelvic peritoneal sac. J Minim Invasive Gynecol 2009; 16 (05) 649-651
    CrossrefPubMedSearch in Google Scholar
  • 2 Jackson AM, Hope ER, Phippen NT. Adnexal incarceration in a posterior pelvic peritoneal defect mimics ovarian torsion. J Minim Invasive Gynecol 2015; 22 (06) 1113-1115
    CrossrefPubMedSearch in Google Scholar
  • 3 Masoumi Shahrbabak M, Ebrahimi Meimand F. A rare case of Mayer-Rokitansky-Küster-Hauser syndrome with right ovarian torsion and hypoplasia of the left adnexa. J Surg Case Rep 2021; 2021 (05) rjab130
    CrossrefPubMedSearch in Google Scholar
  • 4 Fedele F, Bulfoni A, Salvatore S, Candiani M. Fertility options in Mayer-Rokitansky-Küster-Hauser syndrome. Clin Exp Obstet Gynecol 2021; 48 (03) 453-460
    CrossrefSearch in Google Scholar
  • 5 Naem A, Sleiman Z. Unusual torsion of hematosalpinx in a case of MRKH syndrome. J Minim Invasive Gynecol 2023; 30 (02) 85-86
    CrossrefPubMedSearch in Google Scholar
  • 6 Moro F, Bolomini G, Sibal M. et al. Imaging in gynecological disease (20): clinical and ultrasound characteristics of adnexal torsion. Ultrasound Obstet Gynecol 2020; 56 (06) 934-943
    CrossrefPubMedSearch in Google Scholar
  • 7 Shadinger LL, Andreotti RF, Kurian RL. Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. J Ultrasound Med 2008; 27 (01) 7-13
    CrossrefPubMedSearch in Google Scholar
  • 8 Auslender R, Shen O, Kaufman Y. et al. Doppler and gray-scale sonographic classification of adnexal torsion. Ultrasound Obstet Gynecol 2009; 34 (02) 208-211
    CrossrefPubMedSearch in Google Scholar
  • 9 Grunau GL, Harris A, Buckley J, Todd NJ. Diagnosis of ovarian torsion: is it time to forget about Doppler?. J Obstet Gynaecol Can 2018; 40 (07) 871-875
    CrossrefPubMedSearch in Google Scholar
  • 10 Lam A, Nayyar M, Helmy M. et al. Assessing the clinical utility of color Doppler ultrasound for ovarian torsion in the setting of a negative contrast-enhanced CT scan of the abdomen and pelvis. . 2015;40(8):3206–3213
  • 11 Adnexal torsion in adolescents: ACOG committee opinion No, 783. Obstet Gynecol 2019; 134 (02) e56-e63
    CrossrefPubMedSearch in Google Scholar
  • 12 Sasaki KJ, Miller CE. Adnexal torsion: review of the literature. J Minim Invasive Gynecol 2014; 21 (02) 196-202
    CrossrefPubMedSearch in Google Scholar
  • 13 Nichols DH, Julian PJ. Torsion of the adnexa. Clin Obstet Gynecol 1985; 28 (02) 375-380
    CrossrefPubMedSearch in Google Scholar
  • 14 McGovern PG, Noah R, Koenigsberg R, Little AB. Adnexal torsion and pulmonary embolism: case report and review of the literature. Obstet Gynecol Surv 1999; 54 (09) 601-608
    CrossrefPubMedSearch in Google Scholar
  • 15 Oelsner G, Cohen SB, Soriano D, Admon D, Mashiach S, Carp H. Minimal surgery for the twisted ischaemic adnexa can preserve ovarian function. Hum Reprod 2003; 18 (12) 2599-2602
    CrossrefPubMedSearch in Google Scholar
  • 16 Demir H, Scoccia B. Internal herniation of adnexa through a defect of the broad ligament: case report and literature review. J Minim Invasive Gynecol 2010; 17 (01) 110-112
    CrossrefPubMedSearch in Google Scholar
  • 17 Allen WM, Masters WH. Traumatic laceration of uterine support; the clinical syndrome and the operative treatment. Am J Obstet Gynecol 1955; 70 (03) 500-513
    CrossrefPubMedSearch in Google Scholar
  • 18 Chatman DL, Zbella EA. Pelvic peritoneal defects and endometriosis: further observations. Fertil Steril 1986; 46 (04) 711-714
    CrossrefPubMedSearch in Google Scholar
  • 19 National Institutes of Health. . National Center for Translational Sciences. Alagille Syndrome/Disease/Symptoms. Office of Rare Diseases Research. Accessed April 20, 2015 at: https://rarediseases.info.nih.gov/gard/804/alagille-syndrome/resources/9
  • 20 Ardelt M, Dittmar Y, Scheuerlein H, Bärthel E, Settmacher U. Post-operative internal hernia through an orifice underneath the right common iliac artery after Dargent's operation. Hernia 2014; 18 (06) 907-909
    CrossrefPubMedSearch in Google Scholar
  • 21 Dumont KA, Wexels JC. Laparoscopic management of a strangulated internal hernia underneath the left external iliac artery. Int J Surg Case Rep 2013; 4 (11) 1041-1043
    CrossrefPubMedSearch in Google Scholar
  • 22 Carugno J, Naem A, Ibrahim C. et al Is color Doppler ultrasonography reliable in diagnosing adnexal torsion? A large cohort analysis. Minim Invasive Ther Allied Technol 2022; 31 (04) 620-627
    CrossrefPubMedSearch in Google Scholar