Laparoscopic detorsion for bilateral ovarian torsion in a singleton pregnancy with spontaneous ovarian hyperstimulation syndrome

Abstract

A 26-year-old primigravida with a singleton pregnancy of 9 weeks gestation presented with severe lower abdominal pain, following spontaneous hyperstimulation of the ovaries in a natural conception. Emergency laparoscopy was done and bilateral ovarian torsion with retained vascularity was noted. Bilateral detorsion with ovarian puncture and ovariopexy was performed. A review of international literature suggests that this is the first case reported with bilateral ovarian torsion following spontaneous ovarian hyperstimulation syndrome in a singleton pregnancy.

Ovarian torsion and spontaneous ovarian hyperstimulation syndrome in a twin pregnancy: A case report

“…Recently, mutations of the FSHR gene leading to an increased sensitivity of the receptor to normal levels of hormones have been also described [1], [2], [4], [8], although a standard genetic test has yet to be developed. Several circumstances may increase the levels or biological activity of these glycoproteins:Elevated endogenous levels of hCG can be seen in multiple pregnancies and gestational trophoblastic disease [2]. A variant of β-hCG with higher biological activity could also cause hyperstimulation of the FSHR [1], [8].…”

“…Elevated endogenous levels of hCG can be seen in multiple pregnancies and gestational trophoblastic disease [2]. A variant of β-hCG with higher biological activity could also cause hyperstimulation of the FSHR [1], [8].…”

“…Normally iatrogenic, OHSS mainly occurs in the context of infertility treatments and is extremely rare in spontaneous pregnancies [1], [2], [3], [4], [5]. In contrast with iatrogenic forms, which typically appear earlier [2], [4], [6], [7], spontaneous OHSS usually develops between the 8th and 14th weeks of gestation; it is sometimes familial and recurrent [6], and it can occur in non-pregnant women [5], [7], [8].…”

“…Ovarian torsion occurs in 12%–20% of women with spontaneous OHSS [1], [2]; right adnexal torsion is more common than left [2]. It is crucial to assess the extent of the ischemia and whether gangrene is present to determine whether it is possible to unwind the adnexa or whether adnexectomy is needed [2].…”

Laparoscopic detorsion of the ovary in ovarian hyperstimulation syndrome during the sixth week of gestation: A case report and review

“…However, optimal management for these patients remains unstandardized, and no consensus exists regarding the appropriate surgical approach. Recently, several institutions have reported the usefulness and safety of explorative laparoscopic surgery for the management of ovarian torsion during pregnancy [[3], [4], [5], [6], [7]], but most cases described in the above reports occurred around 10 weeks or later, and there are few reports on laparoscopic surgery for ovarian torsion in OHSS during the early first trimester. Optimal management of ovarian torsion during pregnancy continues to be explored.…”