Twisted ovarian dermoid cyst with sigmoid colon volvulus: a rare cause of closed-loop obstruction

Sachin Santosh Narate; Gowri M. Pisharody; Sher Singh Dagur; Arun Kumar Singh; Shashi Arora

doi:10.18203/2349-2902.isj20251192

Authors

Sachin Santosh Narate Department of GI & General Surgery, Yashoda Hospital & Research Centre, Ghaziabad, Uttar Pradesh, India
Gowri M. Pisharody Department of GI & General Surgery, Yashoda Hospital & Research Centre, Ghaziabad, Uttar Pradesh, India
Sher Singh Dagur Department of GI & General Surgery, Yashoda Hospital & Research Centre, Ghaziabad, Uttar Pradesh, India
Arun Kumar Singh Department of GI & General Surgery, Yashoda Hospital & Research Centre, Ghaziabad, Uttar Pradesh, India
Shashi Arora Department of Obstetrics and Gynaecology, Yashoda Hospital and Research Centre, Ghaziabad, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20251192

Keywords:

Ovarian dermoid cyst, Closed-loop obstruction, Ovarian torsion, Sigmoid colon volvulus, Exploratory laparotomy

Abstract

Ovarian dermoid cysts (mature cystic teratomas) are common benign ovarian tumors, but they rarely cause intestinal obstruction. We present an extremely rare case of a large twisted left ovarian dermoid cyst with an edematous pedicle, around which the sigmoid colon had looped, leading to a closed-loop obstruction, rarely seen in young adults, which can be a life-threatening condition, if remains untreated. A 34-year-old female presented with left lower abdominal pain since three days, associated with obstipation and multiple episodes of non-bilious vomiting. Contrast-enhanced computed tomography (CECT) of the abdomen revealed a large left ovarian dermoid cyst with a twisted pedicle, causing sigmoid colon entrapment and luminal narrowing. She underwent an emergency exploratory laparotomy with resection of the redundant sigmoid colon and side-to-side colocolic anastomosis alongwith left oophorectomy. The patient had an uneventful recovery and was discharged on post-operative day 6 with soft diet and a healthy wound. This case highlights a rare but significant complication of ovarian dermoid cysts leading to intestinal obstruction.

Metrics

Metrics Loading ...

References

Tsafrir Z, Hasson J, Levin I, Solomon E, Lessing JB, Azem F. Adnexal torsion: cystectomy and ovarian fixation are equally important in preventing recurrence. Eur J Obstet Gynecol Reprod Biol. 2012;162(2):203-5. DOI: https://doi.org/10.1016/j.ejogrb.2012.02.027

Mevada SA, Bhosale AA, Mehendale MA. A rare case report of ovarian torsion with sigmoid volvulus. Int J Reprod Contracept Obstet Gynecol. 2020;9:3055-7. DOI: https://doi.org/10.18203/2320-1770.ijrcog20202757

Buckle AE. Sigmoid Volvulus Associated With Torsion or an Ovarian Cyst. Br J Surg. 1963;50:449-50. DOI: https://doi.org/10.1002/bjs.18005022220

Pagliari M. Torsion of an ovarian cyst associated with a volvulus of the Sigmoid. Quad Clin Obstet Gynecol. 1962;17:197-200.

Oren D, Atamanalp SS, Aydinli B, Yildirgan MI, Başoğlu M, Polat KY, et al. An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases. Dis Colon Rectum. 2007;50(4):489-97.

Osiro SB, Cunningham D, Shoja MM, Tubbs RS, Gielecki J, Loukas M. The twisted colon: a review of sigmoid volvulus. Am Surg. 2012;78(3):271-9. DOI: https://doi.org/10.1177/000313481207800331

Shepherd JJ. The epidemiology and clinical Presentation of sigmoid volvulus. Br J Surg. 1969;56:353. DOI: https://doi.org/10.1002/bjs.1800560510

Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics. 2008;28(5):1355-68. DOI: https://doi.org/10.1148/rg.285075130

Sule AZ, Ajibade A. Adult large bowel obstruction: a review of clinical Experience. Ann Afr Med. 2011;10(1):45-50. DOI: https://doi.org/10.4103/1596-3519.76586

Balthazar EJ, Birnbaum BA, Megibow AJ, Gordon RB, Whelan CA, Hulnick DH. Closed-loop and strangulating intestinal obstruction: CT signs. Radiology. 1992;185(3):769-75. DOI: https://doi.org/10.1148/radiology.185.3.1438761

Bruusgard C. Volvulus of the sigmoid colon and its treatment. Surgery. 1947;22:466-78.

Retraction. Clinical presentation and diagnosis of Sigmoid volvulus: outcomes of 40-year and 859-Patient experience. J Gastroenterol Hepatol. 2009;24:1154. DOI: https://doi.org/10.1111/j.1440-1746.2007.04946.x

Weingrow D, McCague A, Shah R, Lalezarzadeh F. Delayed presentation of sigmoid volvulus in a young woman. West J Emerg Med. 2012;13(1):100-2. DOI: https://doi.org/10.5811/westjem.2011.4.6720

Townsend CM. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 21st edition. Elsevier - Health Sciences Division. 2021.

Gershenson DM. Management of borderline ovarian tumours. Best Pract Res Clin Obstet Gynaecol. 2017;41:49-59. DOI: https://doi.org/10.1016/j.bpobgyn.2016.09.012

Al-Rshoud F, Kilani R, AL-Shara EA. Sigmoid colon volvulus immediately after ultrasound-guided simple ovarian cyst aspiration: a case report. Middle East Fertil Soc J. 2017;22:84-6. DOI: https://doi.org/10.1016/j.mefs.2016.09.003

Oren D, Atamanalp SS, Aydinli B, Yildirgan MI, Başoğlu M, Polat KY, et al. An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases. Dis Colon Rectum. 2007;50(4):489-97. DOI: https://doi.org/10.1007/s10350-006-0821-x