A case of excision of ovarian torsion necrosis due to luteoma in a female who conceived a twin pregnancy through in vitro fertilization misdiagnosed with acute appendicitis

Abstract

The aim of this study was to describe a case of ovarian torsion necrosis due to delayed treatment of luteoma in a woman with IVF twin pregnancy who was misdiagnosed with acute appendicitis. We summarized the clinical manifestations and diagnosis of luteoma in a woman with IVF twin pregnancy and reviewed the relevant literature. We report the case of a 34-year-old Asian female who became pregnant through in vitro fertilization (IVF) and had acute right underbelly pain at 26 weeks and 6 days of gestation, which was misdiagnosed as acute appendicitis. Written consent was obtained from the patient. After fasting for a short duration and receiving anti-inflammatory and intravenous fluid replacement treatment after admission, the woman experienced increased right lower abdominal pain without relief and decreased fetal movement. B-ultrasound and CT examination showed that luteoma torsion was possible, and we performed emergency surgical laparotomy. During the operation, it was found that the right ovary was enlarged, the fallopian tube was twisted 720 degrees, and there was no lesion in the appendix. The right necrotic ovary was removed, and pathological results showed a hemorrhagic corpus luteum in the right ovary. The patient’s abdominal pain was relieved after the operation and the pregnancy was continued. This is a typical case of ovariectomy associated with a luteoma of pregnancy. Whether in vitro fertilization and related procedures increase the risk of luteoma and whether they increase the risk of ovarian torsion necrosis in the case of luteoma formation are questions that need further study.

摘要

本研究的目的是报道一位试管婴儿双胎妊娠的女性因卵巢黄体囊肿被误诊为急性阑尾炎延误治疗而导致的卵巢扭转坏死的病例。总结了一位试管婴儿双胎妊娠女性卵巢黄体囊肿的临床表现和诊断, 并回顾了相关文献。我们报告了一例34岁的亚洲女性通过体外受精（IVF）妊娠, 在妊娠26周6天时出现急性右下腹疼痛, 被误诊为急性阑尾炎。该患者已签署书面知情同意。入院后短期禁食并接受抗炎和静脉补液治疗后, 该患者右下腹疼痛加剧, 但没有缓解, 胎动减少。B超和CT检查提示有黄体囊肿扭转的可能, 我们紧急进行了开腹手术。术中发现右侧卵巢增大, 输卵管扭曲720度, 阑尾无病变。右侧坏死的卵巢被切除, 病理结果显示右侧卵巢内有出血的黄体。术后患者腹痛缓解, 继续妊娠。这是一个典型的妊娠伴有黄体囊肿患者行卵巢切除术的病例。体外受精和相关手术是否会增加黄体囊肿的风险, 以及在黄体囊肿形成的情况下是否会增加卵巢扭转坏死的风险, 这些问题都需要进一步研究。

Keywords:

• Luteoma
• twin pregnancies
• acute appendicitis
• right lower abdominal pain
• Ovary

关键词:

• 黄体囊肿
• 双胎妊娠
• 急性阑尾炎
• 右下腹疼痛
• 卵巢

Disclosure statement

We declare that all authors have approved the submission of the manuscript. This is an original work, which has not been published before. The corresponding author shall take full responsibility for the content submitted. We demonstrate that all authors have made significant contributions to this article and agree to submit it to the Journal of Gynecological Endocrinology. All authors verify the author list and shall not make any modification to the author list without the formal approval of the editor in chief.

Additional information

Funding

The author wish to acknowledge support from the Basic Research Project of Changzhou science and Technology Bureau under grant number CJ20200110.