Ovarian torsion in in vitro fertilization-induced twin pregnancy: combination of Doppler ultrasound and laparoscopy in diagnosis and treatment can quickly solve the case.
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.
Arena
Saverio
S
S.C. Ostetricia e Ginecologia, Azienda Ospedaliera S. Maria della Misericordia, Perugia, Italy. Electronic address: arenasft@tin.it.
Canonico
Silvia
S
S.C. Ostetricia e Ginecologia, Azienda Ospedaliera S. Maria della Misericordia, Perugia, Italy.
Luzi
Giuseppe
G
S.C. Ostetricia e Ginecologia, Azienda Ospedaliera S. Maria della Misericordia, Perugia, Italy.
Epicoco
Giorgio
G
S.C. Ostetricia e Ginecologia, Azienda Ospedaliera S. Maria della Misericordia, Perugia, Italy.
Brusco
Gian Francesco
GF
S.C. Ostetricia e Ginecologia, Azienda Ospedaliera S. Maria della Misericordia, Perugia, Italy.
Affronti
Giuseppe
G
S.C. Ostetricia e Ginecologia, Azienda Ospedaliera S. Maria della Misericordia, Perugia, Italy.
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