BACKGROUND: Torsion of adnexa usually manifests with severe abdominal pain and is treated as an acute surgical emergency. Asymptomatic torsion, necrosis and amputation of an ovary, and sometimes with other adnexal structures as well, are extremely rare. CASE: A 69-year-old Japanese woman presented to her practitioner complaining of dull lower abdominal pain. She was referred to us for presumed uterine tumor. Pelvic examination, ultrasonography and magnetic resonance imaging revealed a 7-cm, multicystic ovarian mass with solid component, and her serum CA125 and CA19-9 were elevated to 110.5 and 92 U/mL, respectively. Two months after the onset of abdominal pain, laparotomy was performed. In the cul-de-sac, the patient was found to have a mass with no ligamentous or direct connection with the pelvic organs. The right ovary seemed atrophic, with a rough surface. These findings were interpreted as an autoamputation of an ovarian cyst arising from the right ovary. CONCLUSION: Physicians should bear in mind the possibility of an autoamputated ovarian cyst even if the preoperative radiograph shows no calcification.
BACKGROUND: Torsion of adnexa usually manifests with severe abdominal pain and is treated as an acute surgical emergency. Asymptomatic torsion, necrosis and amputation of an ovary, and sometimes with other adnexal structures as well, are extremely rare. CASE: A 69-year-old Japanese woman presented to her practitioner complaining of dull lower abdominal pain. She was referred to us for presumed uterine tumor. Pelvic examination, ultrasonography and magnetic resonance imaging revealed a 7-cm, multicystic ovarian mass with solid component, and her serum CA125 and CA19-9 were elevated to 110.5 and 92 U/mL, respectively. Two months after the onset of abdominal pain, laparotomy was performed. In the cul-de-sac, the patient was found to have a mass with no ligamentous or direct connection with the pelvic organs. The right ovary seemed atrophic, with a rough surface. These findings were interpreted as an autoamputation of an ovarian cyst arising from the right ovary. CONCLUSION: Physicians should bear in mind the possibility of an autoamputated ovarian cyst even if the preoperative radiograph shows no calcification.