A 28-year-old woman with a 33-week pregnancy presented to our ED with acute left groin pain of increasing severity, which started at noon on the same day and spread to the left side of her abdomen. According to the patient's declaration, she had her first pregnancy acquired by intrauterine insemination (IUI) in another center. A complete review of her medical history revealed no record of a disease, drug use, or surgery.
The patient's vital signs were unremarkable except for tachycardia. Physical examination revealed defense musculaire and rebound tenderness on the left lower quadrant of the abdomen. On admission, she was given intravenous hydration and symptomatic treatment for the preliminary diagnosis of acute abdomen.
In laboratory studies, complete blood count revealed leukocytosis (13.100/muL), neutrophilia (12.150/muL), and anemia (hemoglobin: 11.3 g/dL), whereas urine analysis showed no abnormal findings. A complete abdominal USG examination performed by a radiologist showed the presence of fetal heartbeat and bilateral multicystic (each with an average size of 4 cm x 5 cm) ovaries with dimensions of 9 cm x 10 cm. However, ovarian blood flow was not clearly demonstrated by Doppler USG. Due to the absence of a diagnostic result by USG and a progression of symptoms despite treatment, noncontrast MRI was scheduled after obtaining informed consent. MRI showed cysts that may be secondary to IUI, reaching 6.5 cm in the right ovary and 6 cm in the left ovary [Figure 1]. In addition, MRI showed signs suggestive of OT in the left ovary, including peripherally arranged cysts, microcysts harboring the peripheral hypointense hemosiderin ring, marked stromal edema, free fluid in the inferior part of the ovary, and suspected whirlpool sign in the vascular pedicle [Figures 2 and 3]. Finally, the patient was diagnosed with OT and transferred to the department of obstetrics and gynecology. The patient underwent an emergency operation and was discharged after 3 days of hospitalization.