Successful Emergency Laparoscopic Right Salpingo-Oophorectomy for Ovarian Torsion in a 26 Y.O. Female

ACE Hospitals’ expert Gynaecology team successfully performed an Emergency Laparoscopic Right Salpingo-oophorectomy on a 26-year-old female patient diagnosed with a right ovarian cyst complicated by pedicle torsion. The procedure aimed to promptly remove the affected ovary and fallopian tube to relieve severe pain, restore proper blood circulation, and prevent tissue damage or further complications.

Chief Complaints

A 26-year-old female patient with a body mass index (BMI) of 21.2 presented to the Gynaecology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of severe pain in the right iliac region lasting for one day, accompanied by nausea and vomiting. The pain did not subside with medications. She also reported irregular menstrual cycles.

Past Medical History

The patient had no significant past medical history and no known drug or food allergies. She had no history of previous deliveries or surgical procedures related to fertility or sterilization.

On Examination

The patient was conscious, coherent, and cooperative on general examination. Vital signs were stable. Systemic examination revealed normal and equal air entry bilaterally in the respiratory system, normal heart sounds (S1 and S2) on cardiovascular examination, and soft breasts without lumps. Abdominal examination demonstrated tenderness in the right iliac region with mild guarding.

Diagnosis

Upon admission to PACE Hospitals, the patient was assessed by the Gynaecology team. Clinical evaluation revealed severe pain in the right iliac region accompanied by nausea and vomiting, with no relief from medications. Menstrual history showed irregular cycles.

Ultrasound imaging confirmed a large right ovarian cyst with pedicle torsion. Intraoperative findings revealed a hemorrhagic cyst measuring approximately 15×10 cm with the right fallopian tube and ovary twisted multiple times, leading to gangrene of the pedicle. Preoperative blood tests were within normal limits.

Based on these findings, the patient was advised to undergo Right Ovarian Cyst With Pedicle Torsion Treatment in Hyderabad, India, under the expert care of the Gynaecology Department, ensuring timely intervention and comprehensive management of the condition.

Medical Decision Making

After a detailed consultation with Dr. Mugdha Bandawar, Obstetrician and Gynecologist, the patient’s condition was thoroughly evaluated. Considering her presentation with severe pain in the right iliac region, nausea, vomiting, and ultrasound findings of a large right ovarian cyst with pedicle torsion, the clinical team carefully assessed the urgency and severity of the condition. The intraoperative findings of a hemorrhagic cyst with a twisted and gangrenous right fallopian tube and ovary confirmed the need for immediate surgical intervention.

It was determined that an emergency laparoscopic right salpingo-oophorectomy was identified as the most appropriate surgical approach to alleviate symptoms, prevent tissue necrosis, and ensure patient safety.

The patient and her family members were counselled regarding the diagnosis, the need for removal of the affected ovary and fallopian tube, the risks involved, expected benefits, and postoperative care. Informed consent was obtained prior to the procedure.

Surgical Procedure

Following the decision, the patient was scheduled to undergo Emergency Laparoscopic Right Salpingo- Oophorectomy Surgery in Hyderabad at PACE Hospitals under the expert supervision of the Gynaecology Department.

The following steps were carried out during the procedure:

• Diagnostic Laparoscopy and Exploration: Under general anesthesia, diagnostic laparoscopy was performed through the umbilical port. On exploration, a huge hemorrhagic cyst measuring approximately 15×10 cm was identified involving the right adnexa. The right fallopian tube was noted to be twisted multiple times around its pedicle, which appeared gangrenous. The right ovary was not visualized separately due to cystic involvement. The left fallopian tube and ovary, uterus, and the rest of the abdominal cavity appeared normal.

• Detorsion and Assessment: The twisted right adnexa was carefully untwisted to assess viability. Despite detorsion, the pedicle remained gangrenous, indicating non-viability of the right fallopian tube and ovary, necessitating removal.

• Salpingo-Oophorectomy: A laparoscopic right salpingo-oophorectomy was performed by meticulously dissecting and removing the gangrenous right fallopian tube and ovary along with the cyst. Care was taken to achieve complete excision and prevent spillage of cyst contents.

• Hemostasis and Specimen Retrieval: Hemostasis was secured using electrocautery to control bleeding from the surgical site. The excised specimen was retrieved intact through the umbilical port using an endoscopic retrieval bag to avoid contamination.

• Closure and Postoperative Care: Following specimen retrieval, the laparoscopic ports were closed in layers. The patient tolerated the procedure well and was shifted to the recovery area for postoperative monitoring.
  

Postoperative Care

The patient’s postoperative period was uneventful. She was initially monitored in the Surgical Intensive Care Unit (SICU) for close observation and supportive care. After achieving hemodynamic stability, she was shifted to the general ward for further recovery. Vital signs remained stable throughout her stay, with no signs of infection or bleeding. She received intravenous antibiotics, analgesics, antiemetics, and fluids as per protocol. Pain was well-controlled, and she tolerated oral intake with gradual mobilization. The patient was discharged in stable condition with follow-up instructions.

Discharge Medications

The patient was prescribed a course of antibiotics to prevent postoperative infections, along with analgesics and antispasmodics for pain relief and muscle relaxation. An anti-inflammatory medication was included to reduce inflammation and aid recovery. A proton pump inhibitor was given to protect the stomach from acid-related irritation. Nutritional supplements were advised to support overall health during the recovery period. 

To prevent constipation, a laxative syrup was prescribed as needed. For local wound care and infection prevention, a topical antibiotic ointment was recommended. Additionally, a probiotic supplement was prescribed to maintain gut health during and after antibiotic therapy.

Advice on Discharge 

The patient was advised to avoid heavy lifting and strenuous exercise during the recovery period. Prolonged sitting was discouraged to prevent discomfort and promote healing. She was instructed to prevent constipation and avoid strenuous coughing to reduce strain on the surgical site.

The patient was recommended to rest for at least two weeks and thereafter avoid excessive stress and long-distance travel. Maintaining a balanced diet and proper sleep hygiene was emphasized to support recovery, prevent hormonal imbalances, and help regulate menstrual cycles. A normal diet was advised to be resumed as tolerated.

Emergency Care

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms like pain in abdomen, heavy menstrual bleeding and fever.

Review and Follow-up Notes

The patient was advised to return for a follow-up appointment with the Gynecologist in Hyderabad at PACE Hospitals after 15 days with a biopsy report.

Conclusion

This case highlights the successful emergency management of a right ovarian cyst with pedicle torsion through laparoscopic right salpingo-oophorectomy. Prompt diagnosis and surgical intervention prevented further complications such as gangrene and preserved the patient’s overall health. The patient’s postoperative recovery was uneventful, and appropriate follow-up care was ensured to support full recovery.

Gynaecology Department | Gynaecology Hospital in Hyderabad