A 28-year-old female presents with sudden onset of severe, sharp, left lower quadrant pelvic pain accompanied by nausea and repeated vomiting. Pelvic ultrasound reveals an enlarged, edematous left ovary measuring 7 cm with absent arterial and venous blood flow on Doppler interrogation. What is the immediate definitive management?
Answer and explanation
Correct answer: C. Emergency laparoscopic detorsion and ovarian preservation
- Step 1: Ovarian torsion is a gynecological surgical emergency caused by twisting of the infundibulopelvic and utero-ovarian ligaments, compromising vascular perfusion.
- Step 2: Prompt laparoscopy with untwisting (detorsion) preserves ovarian tissue and fertility if performed within the critical viability window.
Answer
Emergency laparoscopic detorsion and ovarian preservation.
Why not the others: 'High-dose intravenous broad-spectrum antibiotics and observation' treats pelvic inflammatory disease, not ischemic mechanical vascular twisting; 'Elective cystectomy scheduled in 2 weeks' will result in complete ovarian necrosis and gangrene; 'Oral non-steroidal anti-inflammatory analgesics and discharge' is medical malpractice.
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