Ovarian torsion in a heterotopic pregnancy: a case report

Background and Aim: Ovarian torsion is one of the rare causes of emergency surgeries during pregnancy. Heterotopic pregnancy is a rare type of pregnancy characterized by embryo implantation in two different locations. occurence of these two complications at the same time is a very rare condition. In this study, we present a rare case of heterotopic pregnancy accompanied by ovarian torsion. Patient presentation: A 33-year-old woman with fourth pregnancy presented with abdominal pain and spotting. Based on the last menstrual period, the gestational age was estimated as 7 weeks and 4 days. Ultrasound results revealed a heterotopic pregnancy with a live embryo in the uterus, a live embryo in the fallopian tube, and abundant fluid in the abdomen. Because of the patient’s unstable vital signs, she was operated and we detected a ruptured right tubal pregnancy with a 5 cm ovarian cyst on the same side and two-folded adnexal torsion. Resolution of the torsion, right salpingectomy and removal of the ovarian cyst were performed. Two days after the operation, the intrauterine embryo had no sign of heart activity; therefore, two doses of misoprostol were prescribed for the patient and curettage was performed. The patient was discharged on the next day with a good general condition. Conclusion: The simultaneous occurance of heterotopic pregnancy and ovarian torsion is a rare condition. In these cases, early diagnosis will help to preserve the ovaries and future fertility and also at the same time, maintain the intrauterine pregnancy. Keywords: Heterotopic pregnancy, Ovarian torsion, Ovarian cyst, Pregnancy.   Received: Nov 8, 2017     Accepted: May 22, 2018