Twist and re-twist of the ovary in a young woman with ribbon-like contralateral ovary and absence of contralateral tube.

A 24-year-old nulliparous Caucasian woman was referred to our Center for a suspicious right adnexal mass detected at ultrasound examination performed in another hospital (Figure a, e). She complained nausea and recurrent pelvic pain in the last two months. On transvaginal ultrasound examination at our Institution, uterus and right ovary were normal (Figure b), the left ovary appeared reduced in size showing a ribbon-like appearance (Figure f); neither pelvic mass not free fluid in the pelvis was detected. After reviewing the ultrasound images of the previous examination (Figure a,e), a diagnosis of ovarian torsion spontaneously solved in two weeks was hypothesized. Probably, an edematous ovary has been misdiagnosed as an ovarian mass. All tumor markers were negative. After three weeks, she experienced another episode of acute pelvic pain. Transvaginal ultrasound examination showed an enlarged right ovary with stromal edema and peripherally displaced antral follicles, corpus luteum within the parenchyma (Figure c), and free fluid in the pelvis. At color Doppler examination, the ovarian parenchyma appeared normally vascularized and the whirlpool sign 1 was identified. A diagnosis of ovarian torsion was made (Figure g). A laparoscopy was performed confirming an enlarged twisted right ovary and a left ovary reduced in size. The left fallopian tube was absent and several pelvic adhesions were also detected. An untwisting procedure with lysis of adhesions was achieved with no surgical complication. An ultrasound examination was planned to be four weeks after surgery. However, it was postponed to 8 weeks after surgery due to the Covid pandemic, and it showed a normal right ovarian parenchyma. (Figure d, h).