Title : Case report: From a case of twisted adnexal mass in mid trimester triplet pregnancy managed laparoscopically
Abstract:
Torsion of uterine adnexa or ovarian mass is an important cause of acute abdominal pain. Adnexal masses are not very common in pregnancy, but due to large use of ultrasound during pregnancy, its frequency has considerably increased during last couple of decades. The overall incidence found in pregnancy ranges from 2-10%. Most of such masses are simple cyst and tend to disappear spontaneously during pregnancy. However, there are still a percentage of masses that persists even in 2nd or 3rd trimester and need to monitored and surgically removed.
Laparoscopic ovarian cystectomy has been described in the literature as case of series but this is the case where bilateral ovarian cyst of about 12.3/9.0cm in rt.ovary and 11.2/5.2cm size in left ovary at 16 weeks gestation was managed exclusively by laparoscopy. A 21 year-old primigravida woman was referred from peripheral hospital with H/O, severe pain in abdomen for 2 days in the month of june 2023. On examination, pt was 16 weeks of pregnant with diffuse ill defined tender lump , which was diagnosed sonographically as bilateral ovarian cyst and rt. sided one is twisted.
She was investigated further with S.CA-125 which was within normal limit, ultrasonography- bilateral enlarged ovaries . containing multiple cysts, poorly defined flow at rt. Ovary and preserved flow in the left ovary on color doppler study, with minimal intraperitoneal collection and 16weeks intrauterine pregnancy.The ovarian mass appeared to be cystic with solid component. In view of the size of the ovarian cyst compressing on the foetus and chances to have a miscarriage or a still birth with the possibility of other health complications, options were discussed with the patients legal guardian to undergo laparoscopic ovarian cyst aspiration and cystectomy, which she agreed upon.
Performing laparoscopic surgery during pregnancy especially in 2nd trimester is reported to be safe and beneficial for pregnant woman with little risk to the fetus. Open technique optical port with 2 ipsilateral and one contralateral port were used and rt sided oophorectomy with left sided cyst aspiration were carried out. The pt. had an uneventful postoperative recovery and subsequent antenatal period. She delivered 3 babies at 35 weeks of pregnancy by caesarean section due to S. PIH. The male baby was asphyxiated and the other 2 female babies were healthy. Wt. of the babies were ..1.7 kg, 1.7kg, 1.5kg. On 7th neonatal day the male baby was died in NICU. Other two healthy babies were discharged on 10th POD of C/S.
