Case Report

A Case of Ovarian Torsion Which Led to Abortion


Ovarian torsion occurs in 10%-22% of pregnant women, and miscarriage occurs in 11%-22% of all pregnancies, both of which are known as gynecological emergencies. The simultaneous occurrence of these two cases is rare. The present study reports a case of ovarian torsion and simultaneous abortion. In this case report, we present a 28-year-old woman in her third pregnancy with a history of two miscarriages. She was referred with an 18-week triplet pregnancy, vaginal pain and bleeding from the previous day, and colic abdominal pain with five episodes of nausea and vomiting. Upon admission to the hospital, despite performing cerclage at 13 weeks, labor pains begin, and 15 minutes later, the amniotic sac ruptures, and all three fetuses are expelled. Due to the persistence of colic pain and moderate tenderness in the lower right quadrant of the abdomen, pelvic ultrasound is reported, which shows an increase in echo parenchyma and the size of the right ovary compared to the left ovary. Doppler ultrasound showed decreased ovarian blood flow, which led to laparotomy with suspected ovarian torsion. The right ovarian peduncle had complete torsion, and the ovary appeared dark. The peduncle of ovarian torsion was opened and preserved. The patient was discharged two days after surgery and after re-color Doppler ultrasounds, which indicated ovarian blood flow.

1. Huang C, Hong M-K, Ding D-C. A review of ovary torsion. Tzu Chi Med J 2017;29:143-7.
2. Gorkemli H, Camus M, Clasen K. Adnexal torsion after gonadotrophin ovulation induction for IVF or ICSI and its conservative treatment. Arch Gynecol Obstet 2002;267:4-6.
3. Pan HS, Huang LW, Lee CY, Hwang JL, Chang JZ. Ovarian pregnancy torsion. Arch Gynecol Obstet 2004;270:119-21.
4. Johnson Jr T, Woodruff J. Surgical emergencies of the uterine adnexae during pregnancy. Int J Gynaecol Obstet 1986;24:331-5.
5. Yen CF, Lin SL, Murk W, Wang CJ, Lee CL, Soong YK, et al. Risk analysis of torsion and malignancy for adnexal masses during pregnancy. Fertil Steril 2009;91:1895-902.
6. Safdarian L, Eslamian L, Adineh M, Aghahoseini M, Aleyasin A, Saidi H. Impact of laparascopic ovarian electrocautery on doppler indices women stromal blood flow in women with polycystic ovary syndrome. Acta Med Iran 2008;46:203-6.
7. Lai TH. The primary application of three-dimensional ultrasonography in obstet. Gynecol 2000;20:400-3.
8. DiLuigi AJ, Maier DB, Benadiva CA. Ruptured ectopic pregnancy with contralateral adnexal torsion after spontaneous conception. Fertil Steril 2008;90:2007.e1-3.
9. De Cherney A, Eichhorn J. Case 3-1996: severe abdominal pain during early pregnancy in a woman with previous infertility. N Engl J Med 1996;334:255-60.
10. Dahmoush H, Anupindi SA, Pawel BR, Chauvin NA. Multimodality imaging findings of massive ovarian edema in children. Pediatr Radiol 2017;47:576-83.
11. Anthony EY, Caserta MP, Singh J, Chen MY. Adnexal masses in female pediatric patients. AJR Am J Roentgenol 2012;198:W426-31.
12. Wilkinson C, Sanderson A. Adnexal torsion—a multimodality imaging review. Clin Radiol 2012;67:476-83.
13. Albayram F, Hamper UM. Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation. J Ultrasound Med 2001;20:1083-9.
14. Oelsner G, Cohen SB, Soriano D, Admon D, Mashiach S, Carp H. Minimal surgery for the twisted ischaemic adnexa can preserve ovarian function. Hum Reprod 2003;18:2599-602.
15. Tsafrir Z, Hasson J, Levin I, Solomon E, Lessing JB, Azem F. Adnexal torsion: cystectomy and ovarian fixation are equally important in preventing recurrence. Eur J Obstet Gynecol Reprod Biol 2012;162:203-5.
16. Insunza A, Pablo Fd, Croxatto DH, Letelier LM, Morante M, Croxatto HB. On the rate of tubal pregnancy contralateral to the corpus luteum. Acta Obstet Gynecol Scand 1988;67:433-6.
17. Harkins G. Ovarian torsion treated with untwisting: second look 36 hours after untwisting. J Minim Invasive Gynecol 2007;14:270.
18. Shalev J, Goldenberg M, Oelsner G, Ben-Rafael Z, Bider D, Blankstein J, et al. Treatment of twisted ischemic adnexa by simple detorsion. N Engl J Med 1989;321:546.
19. Ammon Avalos L, Galindo C, Li DK. A systematic review to calculate background miscarriage rates using life table analysis. Birth Defects Res A Clin Mol Teratol 2012;94:417-23.
20. Şimşek M, Naziroǧlu M, Şimşek H, Cay M, Aksakal M, Kumru S. Blood plasma levels of lipoperoxides, glutathione peroxidase, beta carotene, vitamin A and E in women with habitual abortion. Cell Biochem Funct 1998;16:227-31.
21. Sane A, Chokshi SA, Mishra V, Barad D, Shah V, Nagpal S. Serum lipoperoxides in induced and spontaneous abortions. Gynecol Obstet Invest 1991;31:172-5.
22. Draper H, Hadley M. Malondialdehyde determination as index of lipid Peroxidation. Methods Enzymol 1990;186:421-31.
23. Sapmaz-Metin M, Topcu-Tarladacalisir Y, Uz YH, Inan M, Omurlu IK, Cerkezkayabekir A, et al. Vitamin E modulates apoptosis and c-jun N-terminal kinase activation in ovarian torsion–detorsion injury. Exp Mol Pathol 2013;95:213-9.
IssueVol 59, No 3 (2021) QRcode
SectionCase Report(s)
Abortion Ovarian torsion Laparotomy Fertility preservation

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Rasekhjahromi A, Goodarzi S, Kalani N. A Case of Ovarian Torsion Which Led to Abortion. Acta Med Iran. 2021;59(3):182-184.