Images in Endoscopy

Recurrent Torsion of a Noncystic Adnexa After Plication of theUtero-Ovarian Ligament

Noga Fuchs, MD*, Zvi Vaknin, MD, Sharon Berger, MD, and Moty Pansky, MDFrom the Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Zerifin, Israel; affiliated with the Sackler School of Medicine, Tel-Aviv

University, Tel-Aviv, Israel (all authors).

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Fig. 1

Torsion of a no

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ncystic adnexa.

Fig. 2

Torsion of adnexa with an intac

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anies described in this article.

uthor: Noga Fuchs, MD, Department of Obstetrics and

af Harofe Medical Center, Zerifin 70300, Israel.

chs@yahoo.com

, 2011. Accepted for publication August 19, 2011.

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.2011.08.719

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A 33-year-old woman experienced right lower quadrantcolic abdominal pain for 2 days. Findings at clinical exami-nation and sonography were suggestive of right adnexal tor-sion. Laparoscopy revealed torsion of a noncystic adnexa,

and detorsion was performed. Three months later, thewomen reported the same symptoms. Findings at evaluationwere suggestive of recurrent torsion of the noncystic adnexa.Repeat laparoscopic detorsion was performed, with fixationof the right adnexa via plication of the utero-ovarian liga-ment. Two years later, the woman reported right flank painradiating to the right side of the groin. The right adnexawas tender, and sonography demonstrated an edematousovary and absent Doppler flow. After thorough explanationof the procedure, laparoscopy was performed, which re-vealed recurrent torsion of the noncystic right adnexa(Figs. 1 and 2), with an intact plication suture (Fig. 2). Aright-sided salpingo-oophorectomy was performed.

Fuchs et al. Recurrent Torsion of a Noncystic Adnexa 287

Adnexal torsion accounts for 3% of all emergency gyne-cologic surgical procedures [1]. The risk of recurrence isincreased when torsion involves a noncystic adnexa [2].Prevention of recurrence relies on oophoropexy [3]. Wehave recently reported a case series of 8 women who un-derwent oophoropexy via different approaches [4]. In 1 pa-tient, recurrence after oophoropexy was attributed to thesurgical technique, i.e., fixation to the pelvic wall usingan absorbable suture [4]. The case presented here indicatesthat recurrence is still a risk despite appropriate surgicaltechnique, i.e., plication of the utero-ovarian ligament us-ing a non-absorbable suture. Attention should be given to

the possibility of a different clinical manifestation afterfixation.

References

1. Hibbard LT. Adnexal torsion. Am J Obstet Gynecol. 1985;152:456–461.

2. Pansky M, Smorgick N, Herman A, Schneider D, Halperin R. Torsion of

normal adnexa in postmenarchal women and risk of recurrence. Obstet

Gynecol. 2007;109:355–359.

3. Abes M, Sarihan H. Oophoropexy in children with ovarian torsion. Eur J

Pediatr Surg. 2004;14:168–171.

4. Fuchs N, Smorgick N, Tovbin Y, et al. Oophoropexy to prevent adnexal

torsion: how, when, and for whom? J Minim Invasive Gynecol. 2010;17:

205–208.