Ovarian Torsion Diagnosed in Term Pregnancy

Background: Severe unexplained abdominal pain during pregnancy can be a challenging clinical conundrum. Adnexal torsion is a rare condition in pregnancy, and a gravid uterus at term makes it difficult at times to determine the cause of the severe pain. Case: A 21-year-old gravida 1, para 0, female, at 38 weeks 3 days of gestation, presented with intractable right-sided abdominal and flank pain that did not respond to administration of narcotic medicine. Transabdominal ultrasonography revealed a 10-cm cyst. This finding, with the potential of ovarian torsion and her clinical presentation of intractable pain, led to a decision to perform an urgent cesarean delivery with a right ovarian cystectomy and adnexal detorsion under regional anesthesia. The operation revealed that she did have ovarian torsion. Results: Pathologic analysis of the excised tissues revealed that she had a mucinous cystadenoma. Postoperatively, the patient reported resolution of her pain, and she was discharged routinely on postoperative day 3. Conclusions: Diagnosis of ovarian torsion should be considered in a term pregnancy when a patient presents with a sudden onset of severe lower-abdominal pain and an adnexal mass. This situation should be treated as an emergency. (J GYNECOL SURG 20XX:000)