Ovarian Torsion, Acute

Quandary

Step 1: View clinicals

A 22 year old lady presents with intermittent pain in the right lower abdomen for 2 days, with sudden worsening over the last 4 hours. She also experienced mild fever, nausea and vomiting. Her medical and drug histories are unremarkable. She is nulliparous, with irregular menstrual cycles. Her last period was 7 weeks ago. She has not been sexually active for the last year and has no history of sexually transmitted disease (STDs).


Step 2: Order all relevant investigations

Full Blood Count

WBC: 14,500 Neutrophils: 90% Hb: 12.4 g/dl Hct (PCV): 37% Plt: 356,000/mm3

Urinalysis

Pus cells: 3 - 4 / hpf (normal: < 10 / hpf) RBC: nil / hpf pH: 5.5 Nitrite dipstick test: negative

Beta-hCG

The beta-hCG urinary dipstick test is negative.

Pelvic Ultrasound

A 8 x 10 mixed solid and cystic mass is visualized inferior to the bladder. Color doppler shows no evidence of blood flow. The right ovary cannot be identified. The uterus and left ovary appear normal.


Step 3: Select appropriate management

IV Antibiotics
Methotrexate
Steroids
Urgent Surgery


Score: ★★☆