title: Ovarian torsion in puerperium: A case report and review of the literature.
abstract: BACKGROUND
  Ovarian torsion (OT) is a rare cause of acute abdominal pain that requires prompt recognition and treatment during puerperium. Diagnosis of OT can be challenging due to nonspecific clinical features and uncommon objective findings. The management of OT is often delayed because of diagnostic uncertainty. Early and timely recognition and prompt intervention are crucial to preserve ovarian function and to minimize morbidity.
  
  
  METHODS
  We report a 29-year-old postpartum woman who presented to the emergency department (ED) with severe right flank pain, nausea and anorexia initially considered as renal colic. After further investigation, OT caused by large mucinous cyst was diagnosed. Right-sided salpingo-oophorectomy was performed due to hemorrhagic ovary and huge cystic mass causing ischemic OT.
  
  
  CONCLUSIONS
  OT is often diagnosed based on the clinical presentation, including severe, sharp, sudden onset of unilateral lower abdominal pain and tenderness with a palpable laterouterine pelvic mass and nausea/vomiting. Emergency surgical intervention should be performed if OT is suspected to confirm the diagnosis and uncoil the twist to prevent ovarian damage.
  
  
  CONCLUSIONS
  In conclusion, emergency physicians should be aware of the possibility of OT in postpartum women. Therefore, early and timely surgical intervention should be undertaken.
authors.affiliation: Department of Obstetrics and Gynecology, Kayseri Military Hospital, Kayseri, Turkey.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Aksoy
authors.affiliation: Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey. Electronic address: sezinsaygi@gmail.com.
authors.forename: Sezin
authors.initials: S
authors.lastname: Ozyurt
authors.affiliation: Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey.
authors.forename: Ulku
authors.initials: U
authors.lastname: Aksoy
authors.affiliation: Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Acmaz
authors.affiliation: Department of Obstetrics and Gynecology, Acibadem Kayseri Hospital, Kayseri, Turkey.
authors.forename: Ozge Idem
authors.initials: OI
authors.lastname: Karadag
authors.affiliation: Department of Urology, Acibadem Kayseri Hospital, Kayseri, Turkey.
authors.forename: Mert Ali
authors.initials: MA
authors.lastname: Karadag
keywords: Abdominal pain; Ovarian torsion; Puerperium