Unilateral ovarian and tubal absence: a case report

Background: Unilateral absence of an ovary and fallopian tube is very rare. We report a case of right ovarian and tubal absence discovered during surgery for left adnexal torsion caused by a left ovarian dermoid cyst.Case report: A 19-year-old virgin patient presented by ambulance with worsening lower abdominal pain. She had menarche at age 14 followed by a regular 26-day menstrual cycle. Computed tomography revealed a 10-cm adnexal mass containing fat and calcification, and adnexal torsion was suspected. The patient underwent surgical laparoscopy, and the left adnexa was found in torsion (triple twist), with an edematous, black-bluish, enlarged ovary. We untwisted the pedicle, excised the ovarian cyst, and then noticed the absent right adnexa. Rudimentary right round and infundibulopelvic ligaments were present. We found and removed a solitary 1.5-cm nodule located just below the peritoneum of the cul-de-sac containing cartilage and hair. Pathological examination revealed that the left ovarian cyst was dermoid with marked congestion, and the cul-de-sac nodule was an " old-looking" dermoid cyst. On second-look laparoscopy, the left ovary demonstrated normal color and follicle development. Left tube patency was confirmed by chromopertubation with indigo carmine.Comment: Two etiopathogenic causes are postulated for this very rare case of ovarian and tubal absence with a normal uterus: congenital developmental defect and missed torsion of the adnexa. The present case appears to involve the latter, because the patient had no other genitourinary anomalies. The finding likely resulted from asymptomatic torsion, with a probable ectopic right ovary present in the cul-de-sac.