Surgical Management of a Recurrent Adnexal Torsion in a Young Woman: A Case Report

Introduction Adnexal torsion is a rare gynaecological condition caused by the complete or partial rotation of the ovary and/or fallopian tube around the supporting ligaments, leading to impaired blood flow. [1, 2] Case Presentation A 19 –year-old woman was hospitalised for elective laparoscopic ovarian fixation surgery following a history of recurrent adnexal torsion. The patient has undergone four laparoscopic operations since 2020. During the operations in 2020, 2022 and 2023, the uterine appendages were not reversed, but the visible oedema and cyanosis suggested spontaneous reversal. In 2023, left uterine appendages were fixed using TICRON sutures. Patient’s menstrual cycle is regular 6/29-30. In 2018, an aneurysmal bone cyst was detected in the right groin. Transvaginal ultrasound revealed multiple small calcifications in the uterine muscle to the right, left ovary was measured 45x29mm, with follicles, signs of oedema, right ovary had been removed in a prior operation. No free fluid. During her most recent operation in 2024, left ovarian detorsion, left tubectomy and left ovarian fixation surgery were performed. The left ovary and its utero-ovarian ligament were fixed with Ethibond U-shaped sutures along the round and sacrouterine ligaments. The operation and postoperative period were uneventful and the patient was discharged. Discussion Adnexal torsion is a surgical diagnosis. Minimally invasive methods, such as laparoscopy are the most recommended. [3, 4] Recurrent adnexal torsion is a rare condition that leads to episodes of partial or complete rotation of the ovary. [3] There are several surgical techniques besides ovarian detorsion for reccurent adnexal torsion, such as oophoropexy and utero-ovarian ligament truncation. [5] Conclusions Recurrent adnexal torsion is a complex condition, and this case highlights the importance of surgical strategies to prevent recurrence.