Sangeeta Nath

ABSTRACT Adnexal torsion is an uncommon but serious cause of lower abdominal pain in women and is often difficult to distinguish from other acute abdominal condition; however the possibility of ovarian torsion should be considered when an ovarian mass is discovered in an appropriate clinical setting. If the adnexal torsion is complete and goes undiagnosed and untreated haemorrhagic infarction may occur in the involved ovary and may lead to peritonitis and death. Although ultrasonography is typically the initial emergent examination, computed tomography [CT] and magnetic resonance [MR] imaging may also be useful diagnostic tools. Common CT and MR imaging features of adnexal torsion include fallopian tube thickening, smooth wall thickening of the twisted adnexal cystic mass, ascites, and uterine deviation to the twisted side. Additional imaging findings that can suggest haemorrhagic infarction include eccentric smooth wall thickening exceeding 10 mm in a cystic ovarian mass converging on the thickened fallopian tube and lack of contrast enhancement of the internal solid component or thickened wall of the twisted ovarian mass. In this article we report a case of young female with history of lower abdominal swelling for one month with sudden onset of severe lower abdominal pain and vomiting was found to have right ovarian torsion with a large cyst with signs of haemorrhagic infarction on MR imaging and the patient was treated by open laparotomy and right sided salpingo-oophorectomy with cystectomy which was later confirmed as mature cystic teratoma or dermoid cyst on excisional biopsy.