Adnexal Torsion in Early Pregnancy: The Diagnostic and Management Challenges: A Case Report and Literature Review

Introduction: Adnexal torsion (AT) is a gynecologic emergency with a nonspecific presentation especially in pregnancy. Given the serious implications of delayed therapy on ovarian function and maternal morbidity, the diagnosis of AT should be considered in all pregnant women presenting with acute lower abdominal pain. We present a case of AT complicating an early pregnancy and further delve into literature to highlight the challenges encountered in the management of AT in early pregnancy.

Case Report: A 26 year old priming ravida presented at 8 weeks gestation with acute right sided low abdominal pains for 2 day duration. Her subsequent workup suggested AT necessitating a laparoscopic evaluation where right adnexectomy was carried out due to hemorrhagic and necrotic changes. She was subsequently put on progesterone therapy though she suffered a miscarriage on the 5th day following the surgery. She recovered well from the surgery.

Conclusion: Adnexal torsion is a serious gynecologic emergency in pregnancy. It should be suspected in all cases of acute abdominal pain in pregnancy alongside the other differentials. Early operative intervention should be instituted preferably by laparoscopy in order to preserve ovarian function.