# Adnexal Incarceration in a Posterior Pelvic Peritoneal Defect Associated with Ovarian Torsion: A Case Report

## TL;DR

A case report describes a rare condition where ovarian torsion was associated with adnexal incarceration in a peritoneal defect, requiring surgical intervention.

## Contribution

This is the first reported case of ovarian torsion combined with incarceration in a posterior pelvic peritoneal defect and subsequent peritoneal closure.

## Key findings

- Ovarian torsion was found alongside incarceration of the right ovary and tube into a peritoneal sac.
- Peritoneal defect closure was performed to prevent future torsion and ischemic damage.
- The condition is likely congenital and may predispose to ischemic changes due to restricted detorsion.

## Abstract

Ovarian torsion is one of the gynecological emergencies and surgical intervention is the standard management for ovarian salvage as well as reveals some unexpected anatomical defects that increase the risk of ovarian torsion. We report a case of a 27-year-old single, nulliparous female taken for diagnostic laparoscopy with suspicion of ovarian torsion. Intraoperatively, we found right adnexa torsion (ovary with tube) along with incarceration of the right ovary and tube into the big peritoneal sac, which was located medial to the right uterosacral ligament. Detorsion and careful pulling of the swollen adnexa were done to the outside of the big peritoneal sac using nontraumatic laparoscopic forceps. The left side was normal with normal left adnexa. The patient had a second laparoscopic look with a plan for peritoneal closure of the big peritoneal defect.

There are two cases which have previously reported ovarian incarceration, but were not associated with ovarian torsion, and did not involve peritoneal closure unlike our report of ovarian detorsion and peritoneal defect closure. The etiology of this condition is thought to be likely congenital as there were no other visible etiologies like pelvic trauma, previous surgery, pelvic inflammatory disease, or endometriosis.

Our clinical assessment suggests that a peritoneal sac can enhance the course of ovarian torsion to involve ischemic changes of the ovary when trapped inside of it, by its prevention of spontaneous detorsion. This condition will result in the compression of the cells between the sac wall and subsequent tissue edema enhancing the ischemic effect.