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Ovarian Cystic Teratoma in Pregnant Women: Conservative Management or Prophylactic Oophorectomy?

Acute abdominal pain in pregnancy is common and the differential diagnosis is vast. Mature cystic teratomas are rarely the cause of adnexal torsion during pregnancy and can be difficult to diagnose. Timely surgical intervention is required to avoid ovarian infarction. We report a 22-year-old patient...

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Autores principales: Osto, Muhammad, Brooks, Abigail, Khan, Ayesha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8452376/
https://www.ncbi.nlm.nih.gov/pubmed/34567894
http://dx.doi.org/10.7759/cureus.17354
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author Osto, Muhammad
Brooks, Abigail
Khan, Ayesha
author_facet Osto, Muhammad
Brooks, Abigail
Khan, Ayesha
author_sort Osto, Muhammad
collection PubMed
description Acute abdominal pain in pregnancy is common and the differential diagnosis is vast. Mature cystic teratomas are rarely the cause of adnexal torsion during pregnancy and can be difficult to diagnose. Timely surgical intervention is required to avoid ovarian infarction. We report a 22-year-old patient presenting with sudden right lower abdominal pain. Imaging including bedside Doppler ultrasonography and MRI were negative for signs of acute ovarian torsion. Despite no definitive imaging findings, due to severe pain, we made the decision for diagnostic multi-port laparoscopic examination with possible oophorectomy. The right cystic ovary was noted to be torsed three times around the utero-ovarian ligament. A right oophorectomy was performed. Grossly, cystic teratoma was confirmed with a large amount of hair and sebum, and pathological analysis also confirmed a benign mature teratoma. The patient recovered well and delivered without any complications. Bedside ultrasonography is a highly accessible tool; however, imaging can be uncertain. Despite the rarity of ovarian torsion due to mature teratomas in second- and third-trimester pregnancies, physicians should be aware of the possibility of acute ovarian torsion in a pregnant patient even with uncertain imaging results, especially those with a documented ovarian mass. Early prophylactic surgical intervention preferably with laparoscopy should be pursued for ovarian masses between 5 cm and 10 cm.
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spelling pubmed-84523762021-09-23 Ovarian Cystic Teratoma in Pregnant Women: Conservative Management or Prophylactic Oophorectomy? Osto, Muhammad Brooks, Abigail Khan, Ayesha Cureus Obstetrics/Gynecology Acute abdominal pain in pregnancy is common and the differential diagnosis is vast. Mature cystic teratomas are rarely the cause of adnexal torsion during pregnancy and can be difficult to diagnose. Timely surgical intervention is required to avoid ovarian infarction. We report a 22-year-old patient presenting with sudden right lower abdominal pain. Imaging including bedside Doppler ultrasonography and MRI were negative for signs of acute ovarian torsion. Despite no definitive imaging findings, due to severe pain, we made the decision for diagnostic multi-port laparoscopic examination with possible oophorectomy. The right cystic ovary was noted to be torsed three times around the utero-ovarian ligament. A right oophorectomy was performed. Grossly, cystic teratoma was confirmed with a large amount of hair and sebum, and pathological analysis also confirmed a benign mature teratoma. The patient recovered well and delivered without any complications. Bedside ultrasonography is a highly accessible tool; however, imaging can be uncertain. Despite the rarity of ovarian torsion due to mature teratomas in second- and third-trimester pregnancies, physicians should be aware of the possibility of acute ovarian torsion in a pregnant patient even with uncertain imaging results, especially those with a documented ovarian mass. Early prophylactic surgical intervention preferably with laparoscopy should be pursued for ovarian masses between 5 cm and 10 cm. Cureus 2021-08-21 /pmc/articles/PMC8452376/ /pubmed/34567894 http://dx.doi.org/10.7759/cureus.17354 Text en Copyright © 2021, Osto et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Obstetrics/Gynecology
Osto, Muhammad
Brooks, Abigail
Khan, Ayesha
Ovarian Cystic Teratoma in Pregnant Women: Conservative Management or Prophylactic Oophorectomy?
title Ovarian Cystic Teratoma in Pregnant Women: Conservative Management or Prophylactic Oophorectomy?
title_full Ovarian Cystic Teratoma in Pregnant Women: Conservative Management or Prophylactic Oophorectomy?
title_fullStr Ovarian Cystic Teratoma in Pregnant Women: Conservative Management or Prophylactic Oophorectomy?
title_full_unstemmed Ovarian Cystic Teratoma in Pregnant Women: Conservative Management or Prophylactic Oophorectomy?
title_short Ovarian Cystic Teratoma in Pregnant Women: Conservative Management or Prophylactic Oophorectomy?
title_sort ovarian cystic teratoma in pregnant women: conservative management or prophylactic oophorectomy?
topic Obstetrics/Gynecology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8452376/
https://www.ncbi.nlm.nih.gov/pubmed/34567894
http://dx.doi.org/10.7759/cureus.17354
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