An Unusual Presentation of Subcutaneous Inguinal Hematoma Mimicking Ovarian Torsion: A Case Report.

Background: Ovarian or adnexal torsions occur when an ovary rotates around one of the supporting ligaments, often the infundibulopelvic (IP) ligament. This rotation can cause the blood flow to the ovary to be hindered, and this decrease in perfusion can often present as adnexal pain, nausea, and vomiting. A significant risk factor for developing an ovarian torsion is the presence of an ovarian mass, such as a cyst. The diagnosis of ovarian torsion is a medical emergency, but symptoms typically resolve with prompt surgical intervention. Hematomas occurring within or around the inguinal region have been reported to occur primarily after procedures such as ablations or inguinal hernia repairs. These hematomas commonly present post-operatively and are not typical features in the setting of adnexal torsion.

Case Presentation: We report the case of a 36-year-old woman who presented with severe, acute-onset pelvic pain and prominent bruising on her left groin area following intercourse. A transvaginal ultrasound revealed the presence of a left ovarian cyst and lack of arterial blood flow to the left ovary, indicating the possibility of a left ovarian torsion. The patient underwent diagnostic laparoscopy with left oophorectomy. However, during the procedure an aberrant vessel was identified that branched from the left IP ligament, running through the inguinal canal, and terminated at the anterior abdominal wall. The vessel was ligated intraoperatively, and the patient ultimately recovered without complications. At the time of post-operative evaluation, the patient was without any recurring symptoms. This case report identifies an unusual presentation of symptoms mimicking ovarian torsion with accompanying ipsilateral subcutaneous inguinal hematoma secondary to aberrant pelvic vasculature.

Conclusion: Our patient had an unusual presentation of pelvic pain mimicking ovarian torsion with accompanying ipsilateral subcutaneous inguinal hematoma secondary to aberrant pelvic vasculature. According to our recent literature searches, there is no available clinical information regarding this combination presentation. The goal of this report is to provide insight into diagnosis and treatment for patients with this atypical presentation.