A 23 year old woman presents with intermittent pain in the left lower abdomen for 3 days. The pain was dull at first, but became sharp and colicky last night, with radiation to the left thigh and associated nausea and vomiting. Her medical, surgical and family histories are unremarkable. She is sexually active and is on combined oral contraceptive pills. Her last withdrawal bleed was 21 days ago. She does not smoke, only drinks socially, and denies recreational drug abuse.
WBC: 11,000/mm3 (4,000 - 11,000) N: 57% L: 23% Hb: 12.8 g/dL (12.1- 15.1) Hct: 40% (36.1 - 44.3) Platelets: 158,000/mm3 (150,000 - 400,000)
The urine hCG test is negative
There is a 5.9 × 3.7 cm cystic mass in the left ovary with a fine reticular appearance. The left fallopian tube is dilated and the whirlpool sign is noted in the proximal tube. Doppler flowmetry shows absence of flow along the tubal wall. The uterus is empty, and the right ovary and adnexum appear normal. A small amount of fluid is seen in the pouch of Douglas.
There is a simple cystic mass measuring 6.0 × 3.8 cm in the left ovary; the cystic content is highly attenuated. The left fallopian tube is thickened and dilated, with a diameter of 12 mm, and appears to be twisted. The uterus is deviated towards the left. A small amount of intraperitoneal fluid is present.