Poster Session

P71. Rare cause of acute abdomen: adnexal torsion in 10weeks high risk primigravida

helena savc (SI), katja juvan (SI), ksenija mohorko (SI)

[savc] General hospital Slovenj Gradec, [juvan] General hospital Slovenj Gradec, [mohorko] General hospital Slovenj Gradec

Context: Adnexal torsion may affect females of all ages. Pregnancy is associated with an increased risk of ovarian torsion, but the incidence of torsion during pregnancy is uncertain (1) . We present an unusual case of a pregnant woman who presented to the emergency departement with acute abdominal pain. It was later on confirmed as a torsion of right adnexa in the 10th week of twin pregnancy. Adnexa were removed by laparoscopic surgery and one fetus survived. Objective: We present a rare case with good outcome. Although technically difficult, the operation was finished laparoscopicaly. Methods, patient and interventions: Case report: 33-year-old primigravida, treated for infertility for 3 years who finally got pregnant after intrauterine insemination. She came to the emergency departement with severe lower abdominal pain (VAS 8-9), fatigue and vomiting. Transvaginal US showed one fetus alive and the other without cardiac activity, their sizes corellated 9w4d. Right ovary was blurred and unclear. Lab tests: WBC 25, CRP 66. Crystaline infusion and analgetics were applicated. The abdominal US suggested signs of peritonitis with several abscesses in the lower abdomen. Due to suspected appendicitis a general surgeon was consulted. He suggested explorative laparoscopy which was immediately performed. After entering the abdomen the orientation was difficult, bluish haemorrhagic necrotic masses filled the whole pelvis, a differential diagnosis of heterotopic pregnancy was considered. However, a right adnexal torsion revealed with masive haemorrhagic ishaemic necrosis. The adnexectomy was done and the removal of the preparaton with two endobags was demanding due to lack of space. The postoperative course was uncomplicated, the patient was discharged on the 9th postoperative day. Transvaginal US revealed biamniotic bihoriotic pregnancy with one fetus alive. The patohistologic survey showed severe congestion, bleeding and necrosis in the ovary and the fallopian. Main outcome: We were concerned about the surviellence of the remaining fetus, which presented alive. The due day was on the 17th of July and the pregnancy progression was normal. Result and conclusion: The acute abdomen in a pregnant women is a diagnostically demanding clinical situation. Laparoscopic treatment is the best choice in the first half of pregnancy. Fortunately the adnexectomy did not result in fetal demise.