# Adnexal Torsion During Pregnancy in a Surrogate Patient Post-tubal Ligation: A Case Report

## TL;DR

A surrogate mother with a tubal ligation experienced adnexal torsion during pregnancy, highlighting the need for early diagnosis and surgery to prevent complications.

## Contribution

This case report adds to the literature by emphasizing the importance of high suspicion for adnexal torsion in surrogate pregnancies after tubal ligation.

## Key findings

- Adnexal torsion was diagnosed and surgically treated in a surrogate pregnancy following tubal ligation.
- Initial symptoms and imaging were misleading, but laparoscopy confirmed torsion and resolved the issue.
- The case highlights the need for prompt surgical evaluation to avoid maternal and fetal complications.

## Abstract

Adnexal torsion during pregnancy is rare and is complicated by ambiguous symptoms and often nonspecific imaging findings. Differential diagnoses of torsion include a ruptured ovarian cyst, tubo-ovarian abscess, and appendicitis. A low threshold for the recommended surgical laparoscopy is necessary to avoid delayed diagnosis and fetal or maternal complications. We present a case of a 30-year-old woman at 10 weeks gestation as a surrogate carrier, admitted for progressive, sharp lower right quadrant abdominal pain. On presentation, she was afebrile and vitally stable, with moderate leukocytosis and elevated inflammatory markers. Transvaginal ultrasound showed a 6 x 6 cm adnexal mass/cyst, without ovarian vascular compromise, in addition to a tubular structure indicating possible hydrosalpinx. Initially, her presenting symptoms partially resolved following antibiotics and analgesics, which led us to consider a tubo-ovarian abscess as the culprit. However, upon a recurrence of pain, we proceeded with a diagnostic laparoscopy, with a high suspicion of ovarian torsion. A right adnexal torsion and paratubal cyst were identified; detorsion with preservation of adnexa and cystectomy was performed, with resolution of the pain in the postoperative period. This case underscores the importance of identifying multiple risk factors and complex clinical scenarios for ovarian torsion in premenopausal patients in the context of surrogate pregnancies following tubal ligation. Our findings contribute to the existing literature by emphasizing the need for a high index of suspicion for adnexal torsion, as it is imperative to prevent complications and ensure prompt surgical intervention.