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Torsion of a normal ovary in the third trimester of pregnancy: a case report

DOI: 10.1186/1752-1947-2-378

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A 32-year-old Omani woman at 32-weeks gestation (gravida 2 para 1) was admitted with right iliac fossa pain, nausea and vomiting of 2 days duration, as well as a history of a similar episode one month earlier. On examination, a provisional diagnosis of appendicitis was made. Laparotomy revealed, however, that the right ovary was gangrenous and had undergone torsion.Adnexal torsion, though rare, should be kept in mind in the differential diagnosis of lower abdominal pain in advanced gestation. Although in our patient, the affected ovary could not be saved, an early diagnosis using imaging like Doppler of the adnexae will enable early intervention to save the ovaries of the patient, especially in young women.Adnexal torsion is the fifth most common gynecological emergency with a reported incidence of 2.7% [1]. The incidence during pregnancy is one in 5000, occurring mostly in early pregnancy, especially following ovarian stimulation for the treatment of infertility [2]. The clinical symptoms of adnexal torsion in advanced pregnancy are non-specific and could be confused with other causes like appendicitis, cholecystitis and labor. This can lead to a delay in diagnosis and surgical management.We report a case of torsion of a normal ovary during the third trimester of pregnancy.A 32-year-old Omani woman at 32-weeks gestation (gravida 2 para1; G2P1) was admitted with a history of right iliac fossa pain, nausea and vomiting of 2 days duration. She had no fever or urinary symptoms. She reported similar symptoms had occurred one month earlier, when she had presented at a different hospital and was given analgesics which relieved her of the symptoms until the time of the present admission.On examination, the patient was afebrile and her vital signs were stable. Abdominal examination revealed a gravid uterus corresponding to 32 weeks with tenderness in the right lower quadrant. There was no uterine activity. An abdominal ultrasound scan revealed the fetal parameters correspon


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