Large bilateral ovarian cysts with left ovarian torsion and right dermoid cyst

Abstract

We report the case of a 19-year-old patient, with medical history of hypothyroidism and nulligravida, who presented with acute pelvic pain progressing for 5 days. On clinical examination, the patient was stable and had pelvic tenderness. The speculum and vaginal examination were not performed on account of the patient being a virgin. A pelvic magnetic resonance imaging (MRI) was performed showing a cystic right ovarian lesion measuring 9.7 x 7 x 6 cm of benign appearance with swollen ovary probably related to a torsion; associated with a left ovarian lesion measuring 10 x 10 x 6 cm with a double cystic and fatty component in favor of a dermoid cyst (A,B,C). Surgical exploration showed two large bilateral ovarian cysts (D). The right ovary was the site of 3-whirl torsional ischemia. The left ovary presented with a large cyst with a fatty and fluid cartilaginous component (E). The uterus was unicorn with the presence of a rudimentary straight horn. The operative procedure consisted of a bilateral cystectomy with right salpingectomy in order to avoid an ectopic pregnancy on a rudimentary horn. The right ovary revascularized after untwisting and the postoperative course was normal.