An Unusual Presentation of Subcutaneous Inguinal Hematoma Mimicking Ovarian Torsion: A Case Report and Review of Literature




Panzanaro, Victoria
Stallworth, Chrystal
Kremer, Timothy


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Background: Ovarian torsion is a condition in which an ovary rotates around one of the supporting ligaments that provides stabilization and perfusion in the pelvis, and can present as a medical emergency due to the rotation hindering blood flow. This is most often the infundibulopelvic (IP) ligament which connects the ovary to the lateral pelvic wall, but can also occur with other ligaments as well. Inguinal hematomas tend to present as a post-operative finding due to procedures such as inguinal hernia repairs. However, there are little to no reported occurrences of ovarian torsion presenting with inguinal hematoma.

Case Presentation: A 36 year-old female presented to the emergency department with a chief complaint of left lower pelvic pain presenting with a large inguinal hematoma which had occurred two days earlier after intercourse. The patient stated she has a history of inguinal hematomas occurring after intercourse, however she stated that the bruising from this incidence was larger, more painful, and longer lasting than previous occurrences. Patient history includes a hysterectomy with bilateral salpingectomy and a left ovarian cyst that still remained. All laboratory values were unremarkable and vital signs were within normal limits. Using transvaginal ultrasound arterial blood flow to the left ovary was difficult to visualize, however venous blood flow was accounted for. The patient was suspected to have a left ovarian torsion and underwent a diagnostic laparoscopy. The decision was also made with the patient to perform a left oophorectomy due to her left ovarian cyst which can increase the occurrence of ovarian torsion, and was most likely contributing to her recurrence of this type of injury. At the time of surgery, the laparoscopy revealed that the left ovary was not extensively torsed and was adequately perfused. However, during the procedure an aberrant vessel was identified branching off of the IP ligament and terminating along the pelvic wall at the same location in which the inguinal hematoma was presenting externally. This aberrant vessel was ligated via electrocautery, and the patient tolerated the rest of the surgery without complications. The patient recovered and was discharged home with two week and two month follow-up appointments scheduled. These follow-up appointments revealed that her inguinal hematoma and pelvic pain resolved completely and that there was no negative impact to ligating the vessel.

Conclusion: This case investigates a cause of pelvic pain due to aberrant vessels which can present similarly to a case of ovarian torsion. This case serves to provide a possible etiology of pelvic pain presenting with inguinal hematoma, in which there are not many situations similar to this case in the current literature.