Thursday, February 3, 2011


A 40 year old woman presents to the emergency department with acute onset abdominal pain along with waves of nausea and vomiting. The pain is in the lower abdomen, stabbing in quality, radiating to the back, flanks, and groin. There is no fever and no peritoneal signs. The patient says she was just exercising vigorously when the pain occurred. Pregnancy test is negative.

The patient is taken to laparoscopy. The intestines including the appendix appears normal. But this is seen:

Challenge: What is that? What's the diagnosis?

Image shown under Fair Use.


Laura said...

ovarian torsion

Marloes Gooden said...

Torsion of the ovary?
Probably associated with an ovarian cyst.

Brady said...

Epiploic appendagitis

Craig Chen said...

Yes, it is ovarian torsion...i like the thought of epiploic appendagitis though, that's cool

This is ovarian torsion. The image shows marked vascular engorgement and distension. (As for the case title, adnexa in Latin is appendages).

Source: UpToDate, including image, reproduced from Pediatric and Adolescent Gynecology.