{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T18:13:23Z","timestamp":1787940803643,"version":"build-2784847793"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T00:00:00Z","timestamp":1740787200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Ovarian hyperstimulation syndrome (OHSS) is a potentially severe complication of ovulation induction. Although less common than with gonadotropin treatment, OHSS can occur secondary to an excessive dose of clomiphene citrate, a first-line ovulation induction agent. A serious complication of OHSS is ovarian torsion, which demands prompt diagnosis and intervention to prevent permanent damage. This case report highlights a rare case of severe ovarian hyperstimulation syndrome (OHSS) with subsequent ovarian torsion following clomiphene citrate treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation:<\/jats:title>\n                    <jats:p>A 24-year-old woman with primary infertility developed severe OHSS after receiving clomiphene citrate (100 mg twice daily, D2-D16). Her initial symptoms included vomiting and severe abdominal pain. Ultrasound examination revealed an enlarged left ovary (100x65x60mm) with multiple follicles and pelvic effusion. Despite initial conservative management, the patient returned four days post-discharge with worsening symptoms. Emergency laparoscopy revealed vascular congestion of the left ovary and successful detorsion restored normal blood flow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case discussion:<\/jats:title>\n                    <jats:p>this case illustrates severe OHSS complicated by ovarian torsion secondary to an excessive dose of clomiphene citrate. The patient's initial presentation and ultrasound findings were indicative of OHSS, and despite conservative management, progression to ovarian torsion required surgical intervention. The successful detorsion and restoration of blood flow underscore the importance of timely surgical management to prevent irreversible damage, regardless of the ovulation induction agent used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Although clomiphene citrate is generally considered safer than gonadotropins for ovulation induction, it can still induce severe OHSS leading to complications such as ovarian torsion particularly if given in overdosage. This case emphasizes the critical need for vigilant monitoring and prompt surgical intervention in OHSS cases to preserve ovarian function, regardless of the ovulation induction agent used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2025.111111","type":"journal-article","created":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T03:13:02Z","timestamp":1741144382000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Ovarian Hyperstimulation secondary to clomiphene citrate resulting in ovarian torsion: A rare report"],"prefix":"10.1097","volume":"129","author":[{"given":"Hiba Bashir","family":"Hassan","sequence":"first","affiliation":[{"name":"Obstetrics and Gynecology Department, Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmin Bashir","family":"Hassan","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Department, Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yahye Sheikh Abdulle","family":"Hassan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, Jamhuriya University of Science and Technology, Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"6","key":"R1-16-20260423","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1093\/humupd\/8.6.559","article-title":"Epidemiology and prevention of ovarian hyperstimulation syndrome (OHSS): a review","volume":"8","author":"Delvigne,","year":"2002","journal-title":"Hum. Reprod. Update"},{"issue":"1","key":"R2-16-20260423","doi-asserted-by":"crossref","first-page":"351.e1","DOI":"10.1016\/j.fertnstert.2009.12.076","article-title":"Spontaneous ovarian hyperstimuation syndrome in a naturally conceived singleton pregnancy","volume":"94","author":"Ahmed Kamel,","year":"2010","journal-title":"Fertil. Steril."},{"issue":"3","key":"R3-16-20260423","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1093\/humrep\/deh124","article-title":"New insights into the pathophysiology of ovarian hyperstimulation syndrome. What makes the difference between spontaneous and iatrogenic syndrome?","volume":"19","author":"Delbaere,","year":"2004","journal-title":"Hum. Reprod."},{"issue":"1","key":"R4-16-20260423","doi-asserted-by":"crossref","first-page":"66","DOI":"10.4103\/0974-1208.130870","article-title":"Laparoscopic detorsion for bilateral ovarian torsion in a singleton pregnancy with spontaneous ovarian hyperstimulation syndrome","volume":"7","author":"Munshi,","year":"2014","journal-title":"J Hum Reprod Sci"},{"key":"R5-16-20260423","doi-asserted-by":"crossref","DOI":"10.7759\/cureus.36344","article-title":"Adnexal torsion associated with recurrent ovarian Hyperstimulation syndrome: a case report","author":"Misiriyyah,","year":"2023","journal-title":"Cureus"},{"key":"R6-16-20260423","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.ijscr.2019.04.051","article-title":"Laparoscopic detorsion of the ovary in ovarian hyperstimulation syndrome during the sixth week of gestation: a case report and review","volume":"59","author":"Kanayama,","year":"2019","journal-title":"Int. J. Surg. Case Rep."},{"issue":"3","key":"R7-16-20260423","first-page":"248","article-title":"\u201cOvarian Hyperstimulation Syndrome: A Narrative Review of Its Pathophysiology, Risk Factors, Prevention, Classification, and Management.,\u201d","volume":"43","author":"Namavar Jahromi","year":"2018","journal-title":"Iran J. Med. Sci"},{"issue":"10","key":"R8-16-20260423","doi-asserted-by":"crossref","first-page":"3386","DOI":"10.1016\/j.radcr.2023.07.012","article-title":"\u201cOvarian torsion due to ovarian hyperstimulation syndrome diagnosed by sonographic whirlpool sign in the first trimester of pregnancy: a case report,\u201d","volume":"18","author":"Higashide","year":"2023","journal-title":"Radiol Case Rep"},{"issue":"5","key":"R9-16-20260423","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1097\/JS9.0000000000000373","article-title":"The SCARE 2023 guideline: updating consensus surgical CAse REport (SCARE) guidelines","volume":"109","author":"Sohrabi,","year":"2023","journal-title":"Int. J. Surg."},{"issue":"1","key":"R10-16-20260423","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ejogrb.2010.02.006","article-title":"Adnexal torsion: a literature review","volume":"150","author":"Huchon,","year":"2010","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"issue":"5","key":"R11-16-20260423","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1148\/rg.285075130","article-title":"Pearls and pitfalls in diagnosis of ovarian torsion","volume":"28","author":"Chang,","year":"2008","journal-title":"RadioGraphics"},{"key":"R12-16-20260423","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1007\/s00404-011-2033-4","article-title":"Adnexal torsion in a woman undergoing ovarian hyperstimulation with clomiphene citrate therapy: a case report and review of the literature","volume":"285","author":"Shiau,","year":"2012","journal-title":"Arch. Gynecol. Obstet."},{"issue":"10","key":"R13-16-20260423","doi-asserted-by":"crossref","first-page":"3386","DOI":"10.1016\/j.radcr.2023.07.012","article-title":"Ovarian torsion due to ovarian hyperstimulation syndrome diagnosed by sonographic whirlpool sign in the first trimester of pregnancy: a case report","volume":"18","author":"Higashide,","year":"2023","journal-title":"Radiol Case Rep"},{"issue":"15","key":"R14-16-20260423","doi-asserted-by":"crossref","DOI":"10.3390\/jcm12154943","article-title":"How to choose the optimal starting dose of clomiphene citrate (50 or 100 mg per day) for a first cycle of ovulation induction in Anovulatory PCOS women?","volume":"12","author":"Huyghe,","year":"2023","journal-title":"J. Clin. Med."},{"issue":"6","key":"R15-16-20260423","doi-asserted-by":"crossref","first-page":"536.e1","DOI":"10.1016\/j.ajog.2009.11.028","article-title":"Comparison of adnexal torsion between pregnant and nonpregnant women","volume":"202","author":"Hasson,","year":"2010","journal-title":"Am. J. Obstet. Gynecol."},{"issue":"12","key":"R16-16-20260423","doi-asserted-by":"crossref","first-page":"2599","DOI":"10.1093\/humrep\/deg498","article-title":"Minimal surgery for the twisted ischaemic adnexa can preserve ovarian function","volume":"18","author":"Oelsner,","year":"2003","journal-title":"Hum. Reprod."},{"issue":"2","key":"R17-16-20260423","first-page":"23","article-title":"Psychological impact of gynecological diseases: the importance of a multidisciplinary approach","volume":"30","author":"La Rosa,","year":"2018","journal-title":"Italian Journal of Gynaecology and Obstetrics"},{"issue":"562","key":"R18-16-20260423","doi-asserted-by":"crossref","first-page":"e146","DOI":"10.3399\/bjgp09X420572","article-title":"Cell-free fetal DNA and non-invasive prenatal diagnosis","volume":"59","author":"Rafi,","year":"2009","journal-title":"Br. J. Gen. Pract."},{"issue":"9","key":"R19-16-20260423","doi-asserted-by":"crossref","first-page":"915","DOI":"10.3390\/jpm14090915","article-title":"Ovarian Hyperstimulation syndrome (OHSS): a narrative review and legal implications","volume":"14","author":"Gullo,","year":"2024","journal-title":"J Pers Med"},{"issue":"2","key":"R20-16-20260423","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1159\/000506803","article-title":"Closed vs. open oocyte vitrification methods are equally effective for blastocyst embryo transfers: prospective study from a sibling oocyte donation program","volume":"85","author":"Gullo,","year":"2020","journal-title":"Gynecol. Obstet. Investig."},{"issue":"14","key":"R21-16-20260423","article-title":"Fresh vs. frozen embryo transfer in assisted reproductive techniques: a single center retrospective cohort study and ethical-legal implications","volume":"27","author":"Gullo,","year":"2023","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"issue":"4","key":"R22-16-20260423","first-page":"1065","article-title":"Open vs. closed vitrification system: which one is safer?","volume":"26","author":"Gullo,","year":"2022","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"issue":"14","key":"R23-16-20260423","article-title":"Fresh vs. frozen embryo transfer in assisted reproductive techniques: a single center retrospective cohort study and ethical-legal implications","volume":"27","author":"Gullo,","year":"2023","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"R24-16-20260423","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2022\/4842316","article-title":"The role of cell and gene therapies in the treatment of infertility in patients with thyroid autoimmunity","volume":"2022","author":"Medenica,","year":"2022","journal-title":"Int. J. Endocrinol."}],"container-title":["International Journal of Surgery Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2210261225002974?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2210261225002974?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ovid.com\/10.1016\/j.ijscr.2025.111111","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T17:30:35Z","timestamp":1786037435000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1016\/j.ijscr.2025.111111"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":24,"journal-issue":{"issue":"C","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1016\/j.ijscr.2025.111111","relation":{},"ISSN":["2210-2612"],"issn-type":[{"value":"2210-2612","type":"print"}],"subject":[],"published":{"date-parts":[[2025,4]]},"assertion":[{"value":"2025-01-16","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-01","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}