Adnexal Torsion During the Second Trimester of Pregnancy: Mc Burney Incision and Management Strategy

Abstract

The pregnancy was normal. The patient was consulted at 26 weeks of amenorrhea (SA) + 2 days of lateral abdominal pain in the right iliac fossa. The patient was apyretic. A clinical examination found no uterine contractions; the fetal heart rate was normo-oscillating and normo-reactive, the cervix was clinically closed, measuring 43 mm by an endo-vaginal ultrasound. The fetus was estimated to weigh 1054 g (90° to 97° percentile according to the “Collège Français d’Echographie Fœtal”). The blood analysis showed no inflammation (leukocytes 10 g/l and protein c reactive at 8 mg/l). The persistent pain was not relieved with level 2 analgesics and required a titration of morphine without point of call found; thus, an abdominal ultrasound was carried out. Liver and kidney scans were normal, the appendix was not visualized. Magnetic resonance imaging (MRI) showed a right ovarian teratoma 55 mm x 73 mm in size, with an ovary projected forward to the sub-parietal (Figure 1a).