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Laparoscopic management of a torsioned adnexal mass in the third trimester of pregnancy

      Magnetic resonance imaging identified a 7 × 6 cm cystic formation with reduced blood flow and tension in the right adnexa of a 29-year-old patient at 355 weeks gestation (Figure 1a; O: adnexal torsion). The abdomen was entered just beneath the sternum via open laparoscopy because of the advanced pregnancy. Cystectomy was performed after the ovary was detorsioned (Figure 1 b, c, and d; Black arrows: twisted adnexal mass)
      Adnexal torsion is very rare in pregnancy, and its incidence is reported at 1–5 in 10 000 pregnancies.
      • Hasson J
      • Tsafrir Z
      • Azem F
      • Bar-On S
      • Almog B
      • Mashiach R
      • et al.
      Comparison of adnexal torsion between pregnant and nonpregnant women.
      Laparoscopic surgery is associated with a reduced risk of postoperative adverse events.
      • Liu Y-X
      • Zhang Y
      • Huang J-F
      • Wang L
      Meta-analysis comparing the safety of laparoscopic and open surgical approaches for suspected adnexal mass during the second trimester.
      Laparoscopic surgery involves less manipulation of the uterus, which causes fewer uterine contractions, and consequently, fewer spontaneous abortions, preterm labours, and premature deliveries.
      • Guterman S
      • Mandelbrot L
      • Keita H
      • Bretagnol F
      • Calabrese D
      • Msika S
      Laparoscopy in the second and third trimesters of pregnancy for abdominal surgical emergencies.
      Surgeons should be aware that the laparoscopic approach can be safely performed late in pregnancy and may reduce obstetric complications.
      Consent: Consent to publish these images was obtained from the patient.

      References

        • Hasson J
        • Tsafrir Z
        • Azem F
        • Bar-On S
        • Almog B
        • Mashiach R
        • et al.
        Comparison of adnexal torsion between pregnant and nonpregnant women.
        American journal of obstetrics and gynecology. 2010; 202 (536.e1-.e6)
        • Liu Y-X
        • Zhang Y
        • Huang J-F
        • Wang L
        Meta-analysis comparing the safety of laparoscopic and open surgical approaches for suspected adnexal mass during the second trimester.
        Int J Gynaecol Obstet. 2017; 136: 272-279
        • Guterman S
        • Mandelbrot L
        • Keita H
        • Bretagnol F
        • Calabrese D
        • Msika S
        Laparoscopy in the second and third trimesters of pregnancy for abdominal surgical emergencies.
        Journal of gynecology obstetrics and human reproduction. 2017; 46: 417-422

      Linked Article

      • Prise en charge laparoscopique d'une torsion de masse annexielle au troisième trimestre de la grossesse
        Journal of Obstetrics and Gynaecology Canada Vol. 44Issue 4
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          Une imagerie par résonance magnétique a révélé la présence d'une formation kystique de 7 × 6 cm accompagnée d'une réduction du débit sanguin et de tension dans l'annexe droite chez une patiente de 29 ans à 35 SA + 5 j (figure 1a; O : torsion annexielle). Une laparoscopie ouverte a été effectuée immédiatement sous le sternum pour accéder à l'abdomen en raison de la grossesse avancée. La kystectomie a été réalisée après la détorsion de l'ovaire (figure 1b, 1c et 1d; flèches noires : masse annexielle tordue).
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