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.