Torsión Tubo-Ovárica
Femenina 18 años edad , menarquia a los 10 años y primera relación sexual a los 16 años con uso intermitente de condones.Última menstruación el 02 de Abril ( 06 semanas por FUM ),Gestacion 0 Partos 0 presenta intensos dolores pélvicos desde hace 5 días. Fue asistida en otro centro en el cual le indicaron analgésicos- Septal (r ) y como el dolor no cedia posteriormente Enantyum ( r) -, sin mas estudios o chequeos fue enviada a casa. Como el dolor no desaparecia la madre decidio traerla a Emergencias desde donde se le indicó una sonografia transavaginal. Antes del examen sonografico además del dolor muestra signos de escalofríos. La exploración sonografica demuestra utero de pequeño tamaño ,no gestante, con endometrio fino de 2,3 mm, normal.En fondo de saco posterior y en ambas áreas peri-ováricas se aprecia gran cantidad de derrame líquido de tipo hematico, en anexo izquierdo se aprecia gran masa sólida con algunas pequeñas imágenes anecoicas en su interior.La masa mide aprox: 5.6 X 4.4 cm. El anexo en si luce marcadamente engrosado,edematoso. Se concluye con el diagnóstico presuntivo de embarazo ectopico localizado en anexo izquierdo.
Se lleva a cirugía de Emergencia y se procede a la realizar ooforectomia y salpingostomia derecha por torsión de esos dos elementos que se habían colocado en posición izquierda debido al proceso de transposición de esas partes anatómicas. Esto último ha sido una sorpresa para todos...
Female 18 years old, menarche at 10 years old and first sexual intercourse at 16 years old with intermittent use of condoms. Last menstruation on April 02 (06 weeks due to FUM), Gestation 0 Childbirth 0 presents intense pelvic pain for 5 days. She was assisted in another center in which she was prescribed analgesics- Septal (r) and since the pain did not subside Enantyum (r) -, without further studies or check-ups she was sent home. As the pain did not disappear, the mother decided to bring her to the Emergency Department from where a transavaginal sonography was indicated. Before the sonographic examination, in addition to the pain, it shows signs of chills. The sonographic examination shows a small, non-pregnant uterus with a 2.3 mm fine endometrium, normal. In the posterior cul-de-sac and in both peri-ovarian areas, a large amount of hematic fluid leaks is seen, in the left annex, appreciates large solid mass with some small anechoic images inside. The mass measures approx: 5.6 X 4.4 cm. The annex itself looks markedly thickened, edematous. It concludes with the presumptive diagnosis of ectopic pregnancy located in the left annex.
It was taken to Emergency surgery and a right oophorectomy and salpingostomy were performed by torsion of these two elements that had been placed in the left position due to the process of transposition of these anatomical parts. The latter has been a surprise for everyone ..
Tuboovarian Torsion
Female 18 years old, menarche at 10 years old and first sexual intercourse at 16 years old with intermittent use of condoms. Last menstruation on April 02 (06 weeks due to FUM), Gestation 0 Childbirth 0 presents intense pelvic pain for 5 days. She was assisted in another center in which she was prescribed analgesics- Septal (r) and since the pain did not subside Enantyum (r) -, without further studies or check-ups she was sent home. As the pain did not disappear, the mother decided to bring her to the Emergency Department from where a transavaginal sonography was indicated. Before the sonographic examination, in addition to the pain, it shows signs of chills. The sonographic examination shows a small, non-pregnant uterus with a 2.3 mm fine endometrium, normal. In the posterior cul-de-sac and in both peri-ovarian areas, a large amount of hematic fluid leaks is seen, in the left annex, appreciates large solid mass with some small anechoic images inside. The mass measures approx: 5.6 X 4.4 cm. The annex itself looks markedly thickened, edematous. It concludes with the presumptive diagnosis of ectopic pregnancy located in the left annex.
It was taken to Emergency surgery and a right oophorectomy and salpingostomy were performed by torsion of these two elements that had been placed in the left position due to the process of transposition of these anatomical parts. The latter has been a surprise for everyone ..
La cirugia demostró que en realidad habia una torsión ovarica con transposición del ovario y trompa derecha colocados del lado izquierdo (fue la masa detectada por sonografia ) todo esto producido por un quiste ovarico derecho que arrastró el ovario y la trompa llevandolo hasta el lado izquierdo, el quiste presentaba signos de necrosis, todo esto confirmado por el analisis anatomopatologico .
Piezas Quirúrgicas
Fotos cortesia del Dr Y. Salcedo, cirujano ginecologico actuante en el caso
The surgery showed that there was actually an ovarian torsion with transposition of the ovary and right tube placed on the left side (it was the mass detected by sonography), all this produced by a right ovarian cyst that dragged the ovary and the tube taking it to the left side, the cyst showed signs of necrosis, all this confirmed by the pathological analysis.
Surgical Parts
Photos courtesy of Dr Y. Salcedo, gynecological surgeon acting in the case
