scientific program • symposia - American Society for Reproductive ...

laparoscopy treatment.
DESIGN: In this video we show a laparoscopy for unwinding
of the right adnexa of a 33-year old woman with a history
of infertility, presented for IVF treatment. Eight hours after
embryo transfer, the patient presented acute abdominal
pain, abdominal guarding and peritonism. Ultrasound
revealed a solid enlargement of the right adnexa, ovarian
peripheral cystic structures, stromal edema and pelvic
fluid. Doppler evaluation was normal, as it may be in 60% of
adnexal torsion cases.
A laparoscopy was performed. It revealed an edematous,
enlarged and hemorrhagic right adnexa with a multiple
enlarged cysts. The right tube, the utero- ovaric and
infundibulopelvic ligaments were twisted.
Detorsion of the adnexa was performed. It is the preferred
management for adnexal torsion and the best outcome
for a reproductive aged woman. It saves over 90% of
VIDEO PROGRAM
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these ovaries and it is not associated with increased
thromboembolism risk.
HCG twelve days after surgery was positive. The correlation
among IVF, pregnancy and adnexal torsion reaches the
highest incidence in twin pregnancies. In fact, 70% of
adnexal torsions happen in multiple pregnancies.
The patient delivered two healthy babies by c-section at 35
weeks.
MATERIALS AND METHODS: We should change our state of
mind in evaluating patients with abdominal pain after IVF-
adnexal torsion should always be suspect. It is a dangerous
condition and a quick diagnosis is essential for an organ
preserving laparoscopy. It is a safe procedement even
for pregnant women. Combining the physical and image
findings, we may reach the correct diagnosis quickly,
preventing loss of ovarian function and oophorectomy in a
reproductive age women.
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