Adnexal torsion during puerperium as a complication of delayed surgical treatment of ovarian tumor in pregnancy

Ovarian tumors in pregnancy represent a significant issue both in terms of diagnostics and therapy. Increased use of the ultrasound in pregnancy in the last several decades has contributed to the rise in the number of diagnosed asymptomatic adnexal tumors with pregnant women. We present a case of a patient treated in our clinic for asymptomatic ovarian tumor, which was diagnosed in pregnancy. The patient underwent check-ups every four weeks, comprising clinical and sonographical examinations and relevant laboratory and tumor marker tests. The course of pregnancy was normal, with no detected tumor growth and with the tumor marker levels within the reference range. Following an uneventful delivery, she developed abdominal pains during the puerperium, and the adnexal torsion was diagnosed intraoperatively. The attitudes to treating of adnexal tumors in pregnancy are controversial, and there exist no defined treatment protocols. It is, therefore, necessary to make an individual evaluation of each case, and the relevant decisions should be made with the pregnant woman's informed consent. The adnexal torsion in the presented case can be explained by the size of the tumor as well as the progressive reduction of the size of the uterus due to the physical involution during puerperium.