Case Presentation
Α 17-year-old girl was admitted as an emergency to our gynae department
reporting nausea, over ten episodes of vomiting and convulsive pain to
the left lower abdomen. Symptoms initiated 2 hours before admission to
hospital. She had irregular menstrual cycle, and a previously normal
gynecological assessment 2 years ago. She had no history of sexual
intercourses and also no history of any gynecological or any other
abdominal surgery. On admission, blood pressure was 135/75 mmHg, pulse
90/min, body temperature was 36o C and oxygenated
hemoglobin was normal. She had a BMI of 23.
Clinical examination revealed normal bowel movements on auscultation,
but also tense and sensitivity on abdominal palpation mainly to the left
lower quadrant. No vaginal examination was performed, as the patient was
virgo and there was no sign of vaginal bleeding. Peripheral blood test
showed mild leukocytosis 11.100/μL and normal C-reactive protein of
1.3mg/L. The hemoglobin level was of 11.7g/dL. Transabdominal ultrasound
demonstrated a large unilocular cyst of about 8cm in diameter in the
left ovary with reduced vascularity. Based on clinical and ultrasound
findings, there was a high suspicion of ovarian torsion and a computed
tomography (CT) was asked in order to confirm or exclude the potential
diagnosis of ovarian torsion. Decision for surgical treatment with
laparoscopy was thereafter decided. (Fig.1)
Laparoscopy was performed under general anesthesia. Four trocars were
used: one of 12mm diameter at the umbilicus and three peripheral of 5mm
to the lower abdomen. Intraoperative findings included a massively
enlarged fimbrial funnel and a paraorian cystic tumor with torsion of
the distal part of the fallopian tube (Fig.2). The tumor
appeared infarcted, while inflammatory fluid was released after
puncture. Puncturing the hydrosalpinx and completing a detorsion did not
improve the aspect of necrosis. The other ovary was macroscopically
normal as well as the rest of the abdominal cavity. No signs of possible
infectious disease were identified.
In order to preserve ovary, the necrotic mass was resected at the level
of corresponding mesosalpinx from the proximal to the distal end of the
fallopian tube, therefore performing a left salpingectomy. The cystic
tumor was later sent for pathological examination, which indicated acute
hemorrhagic necrosis as well as the presence of a hydrosalpinx were
described.
The patient recovered from the surgery without any complications and was
discharged uneventfully the first postoperative day.