Introduction:

1. Introduction: Torsion of a hyperstimulated ovary occurring post in vitro fertilisation (IVF) is rare. We present a case where the management of a patient with a tortedhyperstimulatedovary was dealt with laparoscopically. Case report: A 37 year old patient in her eighth week of pregnancy presented to the Emergency Department with acute onset right iliac fossa pain. This was an IVF pregnancy with no complications prior to this episode. She presented with an acute abdomen and tachycardia. A pelvic ultrasound scan was performed promptly and demonstrated a normal ongoing intrauterine pregnancy together with a cystic area around the right ovaryand minimal intra-peritoneal free fluid. The ultrasound diagnosis was a heterotopic pregnancy and the patient was placed on the emergency operating theatre list for laparoscopic management. At laparoscopy no instrumentation of the uterus was made and bilateral enlarged hyperstimulated ovaries were noted. The right ovary appeared grossly enlarged with a dusky colour and areas of haemorrhage. Further exploration demonstrated that the ovary was torted at its pedicle. Carefully untwisting the ovary restored normal anatomy. The patient made a prompt recovery with a normal viability scan 24 hours later and ovaries with good blood flow bilaterally. Laparoscopic Management Of ATortedHyperstimulatedOvaryMr Fevzi Shakir MBBS BSc MRCOG, Obstetrics and Gynaecology Registrar1, MrTanerShakir BSc, Medical Student21Department of Obstetrics and Gynaecology, Royal Surrey County Hospital, Guildford, UK, 2University of Bristol, UK Right hyperstimulatedtorted ovary, dusky in appearance with haemorrhage Normal hyperstimulated left ovary Discussion: Ovarian torsion is a rare but recognised complication that can occur in pregnant individuals with hyperstimulated ovaries following IVF [1]. Assisted fertility is increasing and Obstetricians and Gynaecologists together with Emergency Department doctors need to be aware of this possible diagnosis. Prompt diagnosis and management can lead to preservation of the ovary with no deterioration clinically. Laparoscopy together with untwisting of the ovary is a simple and effective technique that should be utilised as first line if appropriate [2]. Restoration of normal anatomy with fallopian tube visible following untwisting of the ovary. References: [1] Gorkemli H, Camus M, Clasen K (2002). Adnexal torsion after gonadotrophin ovulation induction for IVF or ICSI and its conservative treatment. ArchGynecolObstet. Nov;267(1):4-6. [2] Bottomley C, Bourne T (2009). Best Practice & Research Clinical Obstetrics & Gynaecology Volume 23, Issue 5, October, Pages 711-724. AcuteGynaecologyVolume 2: Infection, uterine andovarianpathology.