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Case Reports
. 2017 Aug 23:2017:bcr2016218880.
doi: 10.1136/bcr-2016-218880.

Polycystic ovary syndrome with asynchronous bilateral adnexal torsion in a natural cycle

Shozo Matsuoka  1 , Toru Kobayashi  1 , Soshi Kusunoki  1 , Daiki Ogishima  1
Affiliations
Case Reports

Polycystic ovary syndrome with asynchronous bilateral adnexal torsion in a natural cycle

Shozo Matsuoka et al. BMJ Case Rep. .

Abstract

Cases involving polycystic ovaries (PCOs) with adnexal torsion in a natural cycle without ovulation induction are rare, and no reports of such cases have described asynchronous bilateral adnexal torsion. Here, we report a case of PCO syndrome (PCOS) with asynchronous bilateral adnexal torsion in a natural cycle. The patient was a 37-year-old woman with a history of 2 gravidas 1 para. Her primary complaint was left lower abdominal pain. Ultrasonography and MRI identified multiple uterine myomas occupying the pelvis and the left ovary, with oedematous swelling that had moved ventrally to the uterus. She was diagnosed with adnexal torsion and underwent emergency laparoscopic adnexectomy. Nine months after surgery, she experienced right lower abdominal pain. Ultrasonography revealed suspected right adnexal torsion and she underwent emergency surgery. The right ovary was twisted 540° counterclockwise and swollen to 7 cm in size, with partial polycystic changes. She was histopathologically diagnosed with a PCO, and the final diagnosis, which also considered the endocrine test results, was PCOS. In PCOS, adnexal torsion may occur if the swollen ovary moves because of a hysteromyoma or other cause. Accordingly, torsion should be considered during the follow-up of patients with PCOS.

Keywords: obstetrics and gynaecology; reproductive medicine.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Transabdominal ultrasonography. A 6×2 cm mass was observed at the site of tenderness.
Figure 2
Figure 2
Plain pelvic T2-weighted MRI images: (A) sagittal section and (B) horizontal section. Multiple uterine myomas were identified, and the left oedematous ovary (arrow) had shifted superior-anterior to the uterus. The right ovary was normal in size.
Figure 3
Figure 3
Image of the abdominal cavity. The left ovary was enlarged to approximately 7 cm in size and had moved ventrally to the uterus. It was twisted 540° counterclockwise.
Figure 4
Figure 4
Image of the abdominal cavity. No definite tumour was observed in the left ovary, although small cysts measuring several millimetres in size were detected.
Figure 5
Figure 5
Histopathological image (H&E staining; magnification:). Many ovarian follicles measured 2–7 mm in size.
Figure 6
Figure 6
Enhance CT image. The right ovary had moved anteriorly to the uterus and was swollen to a size of 7×6×3 cm (arrow).
See this image and copyright information in PMC

References

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