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Case Reports
. 2021 Mar;49(3):300060521997743.
doi: 10.1177/0300060521997743.

Corrective surgery using a gridiron incision for abdominal pain caused by a folded ovary in the third trimester of pregnancy

A Mi Kim  1 , Jong Woon Kim  1 , Yoon Ha Kim  1 , Tae Young Kim  1 , Hyun Kyung Ryu  1 , Myeong Gyun Choi  1
Affiliations
Case Reports

Corrective surgery using a gridiron incision for abdominal pain caused by a folded ovary in the third trimester of pregnancy

A Mi Kim et al. J Int Med Res. 2021 Mar.

Abstract

Introduction: Sonography and magnetic resonance imaging (MRI) may be helpful to obtain an accurate diagnosis of acute abdominal pain in pregnancy. Adnexal torsion presenting in the first or second trimester can be confirmed and treated through laparoscopic surgery; however laparoscopic surgery in the third trimester can be difficult owing to the large uterus, and a gridiron incision can be useful.

Case report/case presentation: An 18-year-old gravida 1, para 0 (G1P0) woman at 30 + 4 weeks of gestation presented with sudden-onset cyclic pain in the right lower quadrant. Abdominal ultrasonography showed a normal appendix, and MRI showed a normal appendix and normal ovaries. The patient's prominent tender point was marked and compared with the MR images, which confirmed the mark as the position of the right ovary. Laparotomy was performed through a gridiron incision, and a folded right ovary was identified. The ovary was unfolded, and TachoSil® and Surgicel® were used to maintain the unfolded position. The patient's pain resolved, and her postoperative course was uneventful. She delivered a healthy, 2540-g male baby at 35 weeks' gestation.

Discussion/conclusions: A gridiron incision was useful to treat a folded ovary in the third trimester and to evaluate the adnexa and minimize uterine manipulation.

Keywords: Folded ovary; abdominal pain; gridiron incision; imaging; pregnancy; third trimester.

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Conflict of interest statement

Declaration of conflicting interest: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Prominent tender point and MR image. The marked point was confirmed to match the position of the right adnexa in the MR image. MRI, magnetic resonance.
Figure 2.
Figure 2.
Intraoperative finding of the folded right ovary. The size of the right ovary was normal, but it was flat and folded.
Figure 3.
Figure 3.
Intraoperative findings after fixation of the unfolded ovary. TachoSil® was attached to the front and back of the ovary and fallopian tube. Three Surgicels® were rolled and packed behind the ovary to hold it in place.
See this image and copyright information in PMC

References

    1. Cappell MS, Friedel D. Abdominal pain during pregnancy. Gastroenterol Clin North Am 2003; 32: 1–58. - PubMed
    1. Silja A, Gowri V. Torsion of a normal ovary in the third trimester of pregnancy: a case report. J Med Case Rep 2008; 2: 378–379. - PMC - PubMed
    1. Kilpatrick CC, Monga M. Approach to the acute abdomen in pregnancy. Obstet Gynecol Clin North Am 2007; 34: 389–402. - PubMed
    1. Ryan JP, Pellechia D. Effect of ovarian hormone pretreatment on gallbladder motility in vitro. Life Sci 1982; 31: 1445–1449. - PubMed
    1. Munoz M, Usatine RP. Abdominal pain in a pregnant woman. J Fam Pract 2005; 54: 665–668. - PubMed

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