Torsion of a Large Adnexal Mass after Intercourse

​BY GREGORY TAYLOR, DO, & FRANK SCHELL, DOA 30-year-old woman presented to the ED complaining of pelvic pain. She said she felt an acute onset of sharp lower right pelvic pain during intercourse two days earlier. The pain continued to worsen, becoming diffuse. She was also experiencing nausea, vomiting, malaise, anorexia, and vaginal spotting. She had no history or concern for sexually transmitted disease, and had no fever or vaginal discharge. She had had a previous Cesarean section and bilateral tubal ligation.Her vital signs were a heart rate of 110 bpm, a respiratory rate of 25 bpm, a blood pressure of 113/88 mm Hg, and a pulse ox of 100% on room air. She was in distress, lying flat, and diaphoretic, and she did not want to move. Her abdominal exam revealed a mildly distended abdomen, diffuse tenderness to palpation, with a palpable mass in the right lower quadrant with guarding and rebound. Her genital/urinary exam revealed clotted blood within the posterior vaginal vault, right adnexal tenderness, and no evidence of cervical motion tenderness.A bedside FAST exam showed no evidence of free fluid within her abdomen or pelvis, but showed a large cystic mass within the right lower quadrant. Urine hCG and total beta hCG were negative. Transvaginal ultrasound revealed a multiloculated right adnexal cystic mass measuring 9 cm x 8 cm x 6 cm with little evidence of adequate blood flow to the ovary. (Image A.)Image A. Transvaginal ultrasound revealed a multiloculated right ...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research