Lal Poonam, Nanda Swaroop R, Ruhi Kumari
Department of Obstetrics and Gynaecology, Kurji Holy Family Hospital, Patna, IND.
Cureus. 2025 Jan 6;17(1):e76992. doi: 10.7759/cureus.76992. eCollection 2025 Jan.
Dermoid tumors of the ovary in reproductive age can get complicated by torsion. We report a case in which bilateral dermoid cysts caused bilateral torsion at eight weeks of pregnancy, necessitating laparotomy as well as left oophorectomy and right cystectomy with a successful obstetric outcome. A 25-year-old G3P2 at eight weeks of gestation presented with severe lower abdominal pain in the left iliac fossa area. Ultrasonography (USG) and magnetic resonance imaging (MRI) revealed bilateral adnexal masses (9.4 cm in the right adnexa and 11 cm in the left adnexa), suggestive of bilateral large dermoid cysts. Failure of conservative management led to the diagnosis of ovarian torsion. Exploratory laparotomy was performed after consenting to oophorectomy. On laparotomy, a large left dermoid cyst was twisted three to four times over its pedicle. The whole ovary was replaced by a dermoid cyst, was discolored, and didn't regain its color after detorsion. Therefore, the left oophorectomy and right cystectomy were done. The post-op period and pregnancy remained uneventful. The patient delivered a female baby vaginally at 39 weeks. Therefore, a high index of suspicion should be for the possibility of acute ovarian torsion in pregnancy with a large dermoid cyst or a bilateral tumor, even in the first trimester. Early surgical intervention in such cases can salvage the ovary and reduce the risk of complications for the mother and fetus.
育龄期卵巢皮样囊肿可并发扭转。我们报告一例双侧皮样囊肿在妊娠8周时引起双侧扭转的病例，需要进行剖腹手术以及左侧卵巢切除术和右侧囊肿切除术，产科结局成功。一名25岁、孕3产2、妊娠8周的孕妇，出现左髂窝区域严重下腹痛。超声检查（USG）和磁共振成像（MRI）显示双侧附件包块（右侧附件9.4 cm，左侧附件11 cm），提示双侧巨大皮样囊肿。保守治疗失败导致卵巢扭转的诊断。在同意行卵巢切除术后进行了剖腹探查术。剖腹手术时，一个巨大的左侧皮样囊肿在其蒂部扭转了三到四次。整个卵巢被一个皮样囊肿取代，颜色改变，扭转解除后未恢复颜色。因此，进行了左侧卵巢切除术和右侧囊肿切除术。术后及孕期情况平稳。患者在39周时经阴道分娩一名女婴。因此，对于妊娠合并巨大皮样囊肿或双侧肿瘤的患者，即使在孕早期，也应高度怀疑急性卵巢扭转的可能性。在此类病例中早期手术干预可挽救卵巢，并降低母婴并发症的风险。
