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Case Reports
. 2025 Jan 2;17(1):e76802.
doi: 10.7759/cureus.76802. eCollection 2025 Jan.

Bilateral Adnexal Entanglement: A Diagnostic Challenge in Postmenopausal Women

Maria Rui Torres  1 , Luisa Cunha Silva  1 , Rosália Coutada  2 , Joao Pedro Prata  3 , Paula Pinheiro  1
Affiliations
Case Reports

Bilateral Adnexal Entanglement: A Diagnostic Challenge in Postmenopausal Women

Maria Rui Torres et al. Cureus. .

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.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Abdominopelvic CT showing two adnexal masses (arrows), one of them in a much superior location in relation to the pelvis.
Figure 2
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
Figure 3. Axial MRI scan of the pelvis showing bilateral adnexal masses (white arrows) with predominant fatty components.
Figure 4
Figure 4. Axial MRI scan of the pelvis after gadolinium injection showing the enhancing component (arrows).
Figure 5
Figure 5. Upon surgical inspection, both adnexa were intertwined and placed up in the abdominal cavity, far from their typical anatomical position.
Figure 6
Figure 6. After untangling the adnexal masses, both adnexa were vascularized and no ischemic changes were observed.
See this image and copyright information in PMC

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