Acute Ovarian Torsion | Health Connection by Doctors скачать в хорошем качестве

Acute Ovarian Torsion | Health Connection by Doctors

Acute ovarian torsion during pregnancy is a fairly uncommon complication with a high patient morbidity and fetal mortality if not immediately treated. Ovarian torsion should be considered a clinical diagnosis, and a high level of clinical suspicion is needed by the practitioner to ensure that this diagnosis is not missed. Torsion of the ovary in the third trimester is rare as the compressive effect of the gravid uterus restricts the mobility of the ovarian pedicle. However this case clearly demonstrates that it can occur and needs to be considered as a differential diagnosis when patients present with an acute abdomen. Additionally this highlights the difficulty in producing good quality radiological imaging of the pelvic organs in advanced pregnancy. Radiologists often have limited experience of pelvic imaging in the third trimester, so in all but the most experienced hand, a definitive diagnosis may not be forthcoming. This case serves to remind us of the importance of clinical acumen alongside diagnostic test as well as ensure that the correct incision is performed to ensure good surgical access. Furthermore, ultrasound scan examinations in early pregnancy should also address the cervix and the adnexa leading to early diagnosis and management of ovarian masses, thus avoiding later emergency situations and the possibility of preterm deliveries. The patient presented at 30 weeks of gestation, with a 4-hour history of sudden, severe and constant abdominal pain in the left iliac fossa. She found changing position incredibly painful and examination displayed involuntary guarding and rigidity of the left side of her abdomen. The pain was associated with uncontrollable vomiting. There was no history of vaginal bleeding and normal fetal movements had been felt. Ultrasound assessment demonstrated fetal heart movements, cephalic presentation, and an anterior high lying placenta. Internal os was closed and cervical length was 32 mm. Previous LSCS scar appear healthy for the gestation. On further examination left adnexal region demonstrated approx 6 x 4 cm sized left ovarian dermoid with twisted pedicle. Fetal monitoring using cardiotocography was reassuring. On opening the abdominal cavity through a midline laparotomy incision, a large purple but not necrotic left sided mass was noted. The left ovary was then examined and it was torted thrice and appeared as a purple enlarged structure of 6 × 4 cm. There were some well perfused white parts noted on the ovary on close examination. A cystectomy of the left dermoid and evacuation of blood clots were performed. #ultrasound #fetal #gynecology #Radiology #Obstetrics #ovariancysts #PIMS #medicalemergency gynecological emergency. #physics #trending #electiveultrasound #portableultrasound #privateultrasound #viralvideo #bestultrasound #nephrologist #azoospermia #doppler