Left twisted hydrosalpinx presenting as acute abdomen

Abstract

A 30-year-old para 3 not sterilized was admitted on 18.01.2006 with a history of acute pain in the abdomen of one day duration. She was in the 10 th day post menstrual cycle.. There was no history of dysmenorrhea. From the rest of her history all other non gynecological causes of acute abdomen were ruled out.On examination her vitals were stable barring a mild tachycardia; pulse rate=94/min. Per abdomen examination there was tenderness in the left iliac fossa, no guarding or rigidity and bowel sounds were present. Bimanual pelvic examination revealed normal sized uterus with tender cystic mass in left adnexa approximately 4X4 cm and cervical motion tenderness was positive.An urgent abdominal ultrasound scan was then done which showed a cystic mass in the left adnexa 4X4 cm with fine internal echoes; the left ovary was seen in close relation to this mass. Her urine pregnancy test was negative, hence a diagnosis of either a left ovarian cyst with hemorrhage or a left twisted ovarian cyst was made and the patient was shifted for an emergency laparotomy on 18.01.2006.