Bilateral Adnexal Entanglement: A Diagnostic Challenge in Postmenopausal Women

Abstract

Simultaneous bilateral adnexal entanglement is a rare condition with only a few cases documented in the literature. It represents an exceptional cause of symptomatic pelvic masses, posing unique diagnostic and management challenges. A 56-year-old postmenopausal woman presented to the emergency department with progressive abdominal pain. Imaging revealed bilateral adnexal masses, initially interpreted as secondary lesions to prior abdominal surgeries. Surgical exploration uncovered bilateral adnexal entanglement without evidence of ischemia. Histopathology examination confirmed mature cystic teratomas. This case highlights the complexity of diagnosing adnexal masses in postmenopausal women, especially when imaging findings overlap with benign post-surgical changes. A thorough multidisciplinary approach is essential to avoid delays and ensure accurate diagnosis.

Keywords: bilateral adnexal entanglement; diagnostic challenges; gynecological emergencies; mature cystic teratomas; ovarian masses; postmenopausal women.

Figure 1. Abdominopelvic CT showing two adnexal masses (arrows), one of them in a much superior location in relation to the pelvis.

Figure 2. Sagital T2 MRI images of the pelvis showing bilateral adnexal masses (arrows) with predominant fatty components and internal nodular areas (hyperintense).

Figure 3. Axial MRI scan of the pelvis showing bilateral adnexal masses (white arrows) with predominant fatty components.

Figure 4. Axial MRI scan of the pelvis after gadolinium injection showing the enhancing component (arrows).

Figure 5. Upon surgical inspection, both adnexa were intertwined and placed up in the abdominal cavity, far from their typical anatomical position.

Figure 6. After untangling the adnexal masses, both adnexa were vascularized and no ischemic changes were observed.