Monika Thakur et al JMSCR Volume 07 Issue 11 November 2019 Page 830 JMSCR Vol||07||Issue||11||Page 830-834||November 2019 Adnexal Torsion with Pregnancy: A Case Presentation Authors Monika Thakur 1* , Lalit Mahajan 1 , Hemender Mahajan 2 , Anshul Chamail 3 1 Assistant Professor, Department of Obstetrics and Gynaecology, DYSPGMC Nahan 173001 Himachal Pradesh, India 2 Assistant Professor, Department of Obstetrics and Gynaecology, SLBSGMC Mandi 175021 Himachal Pradesh, India 3 Senior Resident, Department of Radiodiagnosis, DYSPGMC Nahan 173001 , Himachal Pradesh, India *Corresponding Author Monika Thakur Assistant Professor, Department of Obstetrics and Gynaecology, DYSPGMC Nahan 173001 Himachal Pradesh, India Abstract A 24-year-old women, presented with complaints of acute onset lower abdominal pain and vomiting. On clinical examination, a tender mass in the hypogastric region was palpable. Pelvic examination revealed the same mass felt anterior and through the right fornix, along with cervical motion tenderness. She missed her last periods and urine pregnancy test was weakly positive. Laboratory examination included a β-hCG assay with results of 39.8, haemoglobin level of 10.7, and white blood cell count of 9600. Ultrasonography revealed a cystic mass of size 9.9 × 8.5 cm in the right adnexa along with presence of heterogenous area of 5 × 8.2 cm with no vascularity with surrounding free fluid. A provisional diagnosis of chronic ectopic versus ovarian torsion was made as ultrasonographic findings were inconclusive of torsion. Exploratory laparotomy was done which revealed an enlarged, cyanotic and congested fallopian tube along with completely necrotic ovary on right side. Right salpingoopherectomy was performed because after untwisting of vascular pedicle there were no signs of reperfusion. The patient was discharged uneventfully on the fifth postoperative day. This case describes an interesting case of adnexal torsion along with pregnancy which was being misdiagnosed as chronic ectopic because of her positive urine pregnancy test and indeterminate ultrasound findings. Background Ovarian torsion has a prevalence of 2.7% among all cases of acute abdominal pain. It is the fifth most common gynaecological emergency. 1 It is described as interruption of the blood flow to ovary due to partial or complete rotation of adnexa around its vascular axis. Adnexal torsion is a term which is inclusive of either ovary or fallopian tube or both. Concomitant ovarian and tubal torsion occurs in up to 67% of cases of adnexal torsion. 2,3 Ischaemia which follows after torsion leads to necrosis of ovary and may necessitate oopherectomy if there is no viable tissue left during laparotomy/laparoscopy. Thus, timely diagnosis and an early intervention are required in cases of torsion. Also, this becomes more important in young females as extent of surgery has great implications for future fertility. This case http://jmscr.igmpublication.org/home/ ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v7i11.144