45 years old female came with a history of acute abdomen of 7 hours duration, not getting relieved by any medication.
on examination, right ovary was mildly enlarged, a right adnexal non ovarian solid appearing lesion with central cystic change was seen. the uterus appeared normal. the left ovary could not be visualised.
application of colour flow imaging revealed that the right adnexal lesion was a vascular.
presumptive diagnosis of either torsion of right adnexal non ovarian cyst, or torsion of a left ovary with hypermobile mesentry (as left ovary could not be seen) or right sided acute salpingitis or right ectopic pregnancy was made (although less likely in view of avascular nature and h/o tubectomy). Her urine pregnancy test was negative.
The patient was taken up for surgery immediately and a gangrenous right paraovarian cystic lesion was removed.
lessons learnt: always put on colour doppler for any adnexal pathology.....it is essential for the triage of patients and can help narrow the clinical diagnosis and thus help in reducing morbidity.
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