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Clinical Images  |   June 2017
Asynchronous Bilateral Ovarian Torsion
Author Notes
  • From the Department of General Surgery at Garden City Hospital in Michigan. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Jennifer E. Taylor, DO, 31941 Augusta Dr, Romulus, MI 48174-6375. E-mail: jentaylor25@gmail.com
     
Article Information
Endocrinology / Imaging / Obstetrics and Gynecology / Clinical Images
Clinical Images   |   June 2017
Asynchronous Bilateral Ovarian Torsion
The Journal of the American Osteopathic Association, June 2017, Vol. 117, 403. doi:10.7556/jaoa.2017.080
The Journal of the American Osteopathic Association, June 2017, Vol. 117, 403. doi:10.7556/jaoa.2017.080
A 43-year-old woman presented to the emergency department with acute right lower quadrant abdominal pain, nausea, and bloating for the past day. Her medical history included a Roux-en-Y gastric bypass procedure 14 years prior. On abdominal examination she had focal guarding in her right lower quadrant. A computed tomographic scan of her abdomen and pelvis showed a multicystic heterogeneous right ovarian mass. Exploratory laparotomy revealed a large right hemorrhagic ovarian cyst with ovarian torsion of the infundibular ligament and vascular pedicle (image A, arrow). She underwent an oophorectomy. 
Fifty-four weeks later, she presented to her primary care physician with similar abdominal pain in the left lower quadrant. A computed tomographic scan showed a left ovarian mass (image B, arrow). Exploratory laparotomy revealed 540° torsion of her left ovary, and histologic examination revealed a large left hemorrhagic cyst with torsion. The patient underwent an oophorectomy. 
Ovarian torsion can affect women of all ages but rarely occurs in women after menopause.1 It frequently presents as an acute abdomen and thus should be considered in the differential diagnoses in female patients with acute abdominal pain.1 The risk of ovarian torsion is greater for premenopausal women, pregnant women, and women who have hyperstimulated ovaries.1 
Reference
Reference
Ashwal E, Hiersch L, Krissi H, et al Characteristics and management of ovarian torsion in premenarchal compared with postmenarchal patients. Obstet Gynecol. 2015;126(3):514-520. doi: 10.1097/AOG.0000000000000995 [CrossRef] [PubMed]