Shimizu Haruhiko, Sei Kiguna, Oda Aimi, Shimizu Yumi, Adachi Hiroshi
Obstetrics and Gynecology, Seirei Hamamatsu General Hospital, Hamamatsu, JPN.
Cureus. 2024 May 13;16(5):e60194. doi: 10.7759/cureus.60194. eCollection 2024 May.
Massive ovarian edema (MOE) is a rare benign condition presenting as unilateral ovarian enlargement with stromal edema, and only a limited number of MOE cases during pregnancy have been reported. MOE is often complicated by ovarian torsion, which requires detorsion. Although the diagnosis of MOE can be made using ultrasound and magnetic resonance imaging, its rarity makes diagnosis difficult, usually leading to overtreatment. Preserving the ovary in the treatment of MOE torsion is essential, and consideration of oophoropexy after detorsion is often reported. However, fixing an enlarged ovary to the pelvic wall in the limited space of the pelvis is challenging. Herein, we present a case of MOE of the right ovary diagnosed at the fifth week of gestation after ovulation induced by clomiphene citrate. Torsion of the ovary occurred in the seventh week. We achieved preservation of the ovary through laparoscopic surgery with detorsion and drainage by making a small incision to the enlarged ovary, resulting in an immediate size reduction. There was no recurrence of torsion or MOE throughout the pregnancy, and the patient gave birth in the 39th week of gestation. This is the third reported case of MOE after ovulation using clomiphene citrate, and it highlights the effectiveness of treatment with detorsion and a small incision of the ovary via laparoscopic surgery in patients with MOE torsion during pregnancy.
巨大卵巢水肿（MOE）是一种罕见的良性疾病，表现为单侧卵巢肿大伴间质水肿，妊娠期间仅有少数MOE病例的报道。MOE常并发卵巢扭转，需要进行扭转复位。虽然MOE的诊断可通过超声和磁共振成像做出，但其罕见性使得诊断困难，通常导致过度治疗。在MOE扭转的治疗中保留卵巢至关重要，扭转复位后常考虑卵巢固定术。然而，在骨盆有限的空间内将肿大的卵巢固定于骨盆壁具有挑战性。在此，我们报告一例在枸橼酸氯米芬诱导排卵后妊娠第5周诊断为右侧卵巢MOE的病例。卵巢在第7周发生扭转。我们通过腹腔镜手术进行扭转复位和引流，在肿大的卵巢上做一个小切口，使卵巢立即缩小，从而成功保留了卵巢。整个孕期未再发生扭转或MOE，患者在妊娠第39周分娩。这是第三例报道的枸橼酸氯米芬促排卵后发生MOE的病例，它突出了腹腔镜手术对妊娠期间MOE扭转患者进行扭转复位和卵巢小切口治疗的有效性。
