Ovarian Reserve After Ischemic Changes in Ovarian Torsion. A Case Series

This article discusses the management of reproductive age in three women with a delayed diagnosis of adnexal torsion associated with a risk factor whose ovaries were successfully preserved, followed by a laparoscopic second look. All of them presented to the emergency room with a typical history of acute abdominal pain associated with nausea and vomiting. The suspicion of ovarian torsion is supported by gynecology ultrasound and abdominal CT to rule out other causes of acute abdominal pain. Emergency laparoscopy done to all of them confirmed ovarian torsion, two of them 4 times and one of them 7 times with a purple-blackish color, so detorsion done with preservation to the affected ovary. Also during surgery, there were risk factors for all patients, including dermoid cyst, tubal endometerioma cyst, and pelvic peritoneal sac. After the primary procedure, a laparoscopic second look was done after 4 weeks of detorsion, which revealed normal ovary and adnexa in color and structure. At the same time, risk factors were corrected for all patients. Post-operation was uneventfull in both primary and second-look surgery. Also, no ovarian torsion recurrence occurred during the 4-week period between two surgeries with clear instructions given to reduce the aggressive activities. Preserving the ovaries in reproductive women with a delayed diagnosis of ovarian torsion was successful and unharmful.