A case report of ovarian torsion following ovarian transposition for cervical cancer
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CASE REPORT
A case report of ovarian torsion following ovarian transposition for cervical cancer Rebecca Simstein 1
&
William Merenich 2 & Jenny Graber 3 & Michael Ferrell 1
Received: 19 February 2020 / Accepted: 30 March 2020 # American Society of Emergency Radiology 2020
Abstract We describe a case report of ovarian torsion after ovarian transposition in a young woman with cervical cancer. Ovarian transposition is a well-established surgical procedure in young women undergoing hysterectomy for pelvic malignancies who may go on to receive radiation therapy. Transposing the ovaries further from the targeted field lowers the radiation dose to the exquisitely radiosensitive ovaries. Torsion is not a commonly acknowledged complication following ovarian transplantation; however, we feel that clinicians and radiologists should include torsion in their differential for women with flank or abdominal pain and a history of ovarian transposition. Keywords Ovarian transposition . Ovarian torsion . Cervical cancer . Dual source CT
Case report A 28 year-old nulligravid woman presented to our emergency department with acute onset right flank pain, nausea, and vomiting. Fourteen months prior, she had undergone robotic modified radical hysterectomy, bilateral salpingectomy, pelvic lymph node dissection, and ovarian transposition for stage 1b2 cervical cancer. CT of the abdomen and pelvis was obtained using a dualsource CT scanner. Dual-source CT enhances tissue characterization by improving the contrast to noise ratio. Iodine uptake from iodinated contrast is quantified and displayed as either gray scale or color map imaging [1]. The lack of color in the right ovary and ovarian vein on iodine map imaging in our patient correlates with lack of blood flow (Fig. 1). The patient also underwent pelvic MRI, which demonstrated an edema-
* Rebecca Simstein [email protected] 1
Bryn Mawr Hospital Department of Radiology, Bryn Mawr, PA, USA
2
Riddle Memorial Hospital Department of Radiology, Media, PA, USA
3
Riddle Memorial Hospital Department of Obstetrics and Gynecology, Media, PA, USA
tous and hemorrhagic right ovary (Fig. 2) with a dilated right ovarian vein tapering superiorly to a point of torsion (Fig. 3). The left ovary was identified in the left paracolic gutter superior to the iliac crest (Fig. 4). The right ovary had moved from its transposed location in the right paracolic gutter into the pelvis. The patient then underwent exploratory laparoscopy, which revealed a purple, necrotic appearing right ovary and an edematous clot-filled right ovarian vein with a point of torsion proximal to the clot (Fig. 5). Oophorectomy was performed. Pathologic evaluation confirmed hemorrhagic necrosis of the right ovary. Ovarian transposition is a well-established surgical procedure, which involves transposing the ovaries out of the radiation field in women undergoing treatment for pelvic malignancy with either external beam radiation or vaginal brachytherapy [2]. In cervical cancer patients under 40– 45 years of age with early stage
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