title: Ovarian torsion in in vitro fertilization-induced twin pregnancy: combination of Doppler ultrasound and laparoscopy in diagnosis and treatment can quickly solve the case.
abstract: OBJECTIVE
  To diagnose and treat adnexal torsion in pregnancy.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Obstetrics and Gynecology Department of Perugia Hospital.
  
  
  METHODS
  A 38-year-old woman, gravida 2, para 1 with bichorial twin pregnancy in the 10th week of gestation who was admitted for abdominal pain. She conceived after an IVF attempt. Even if symptoms compared 2 days before the admission, they aggravated just 2 hours before.
  
  
  METHODS
  An ovarian torsion was suspected, and Doppler ultrasound showed a complete absence of vascular flow. The dimension of the right ovary and the absence of ovarian blood flow were strong arguments in favor of the diagnosis of adnexal torsion, and laparoscopic ovarian adnexectomy was performed.
  
  
  METHODS
  The ovarian torsion was confirmed, and right adnexectomy was necessary.
  
  
  RESULTS
  The patient had a quick convalescence and was discharged on the third postoperative day. She had no more pain. She underwent a cesarean section for placenta previa. She and her children have remained well.
  
  
  CONCLUSIONS
  Considering the increased number of IVF pregnancies, an ovarian torsion should be less uncommon than in the past. Doppler ultrasound should be considered as a first-line exam. The complete absence of vascular flow in the ovary may be an indication for adnexectomy. An ovarian torsion in pregnancy should be treated laparoscopically.
authors.affiliation: S.C. Ostetricia e Ginecologia, Azienda Ospedaliera S. Maria della Misericordia, Perugia, Italy. Electronic address: arenasft@tin.it.
authors.forename: Saverio
authors.initials: S
authors.lastname: Arena
authors.affiliation: S.C. Ostetricia e Ginecologia, Azienda Ospedaliera S. Maria della Misericordia, Perugia, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Canonico
authors.affiliation: S.C. Ostetricia e Ginecologia, Azienda Ospedaliera S. Maria della Misericordia, Perugia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Luzi
authors.affiliation: S.C. Ostetricia e Ginecologia, Azienda Ospedaliera S. Maria della Misericordia, Perugia, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Epicoco
authors.affiliation: S.C. Ostetricia e Ginecologia, Azienda Ospedaliera S. Maria della Misericordia, Perugia, Italy.
authors.forename: Gian Francesco
authors.initials: GF
authors.lastname: Brusco
authors.affiliation: S.C. Ostetricia e Ginecologia, Azienda Ospedaliera S. Maria della Misericordia, Perugia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Affronti
mesh_terms: D000328:Adult; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D010049:Ovarian Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D011272:Pregnancy, Multiple / Q000502:physiology; D014102:Torsion Abnormality / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome; D014429:Twins, Dizygotic; D014465:Ultrasonics; D014463:Ultrasonography