Surreal illustration of a rolling stone containing adnexal tissue, set against a backdrop of medical imaging scans.

The Mystery of the Rolling Stone: When Your Adnexa Takes a Trip

Soraya Malik in Health & Wellness November 2025 • 4 min read.

"Unraveling the Enigma of Auto-Amputation: A Multimodal Imaging Approach"

Imagine a scenario where a part of your body detaches itself, embarking on a solitary journey within. This might sound like a plot from a science fiction movie, but in rare instances, it's a reality. Adnexal auto-amputation is one such unusual condition, characterized by the spontaneous separation of the fallopian tube and/or ovary.

While the concept might seem alarming, it's crucial to understand that this condition, though rare, is not necessarily life-threatening. However, its diagnosis and management require a keen understanding of imaging techniques and a thoughtful approach to patient care. In most previously reported cases, confirmation or incidental diagnosis of an auto-amputated adnexa was made during surgery.

Now, a recent case study sheds light on the diagnostic journey of a young woman with auto-amputated adnexa, emphasizing the role of multimodal imaging in identifying this elusive condition. Let's delve into the details of this intriguing case and explore its implications.

Decoding Auto-Amputation: What Imaging Reveals

Surreal illustration of a rolling stone containing adnexal tissue, set against a backdrop of medical imaging scans.

The case involves a 26-year-old woman experiencing deep dyspareunia and sporadic right pelvic pain, leading doctors to suspect pelvic endometriosis. Her medical history included undocumented lower back pain, possibly linked to a past right renal colic. During a transvaginal ultrasound, doctors found a normal uterus and left ovary, but no right ovary was found.

The key to diagnosis lay in a series of imaging techniques, each offering unique insights:

Transvaginal Ultrasound (US): Revealed a hypoechoic mass in the pouch of Douglas, exhibiting posterior acoustic shadowing suggestive of calcification. Notably, the mass was mobile, rolling under the probe, and no right ovary was visualized.
Unenhanced Low-Dose Pelvic CT: Performed to confirm the dermoid cyst suspicion, the CT scan revealed a largely calcified mass without fat tissue, reinforcing the absence of a separate right ovary.
Magnetic Resonance Imaging (MRI): Confirmed the absence of the right ovary and revealed a 3cm mass in the pouch of Douglas, unconnected to the genital tract. The mass showed low signal intensity without enhancement, indicative of an amorphous composition.

The imaging results pointed towards adnexal auto-amputation, deviating from the initial suspicion of a dermoid cyst. This multimodal approach proved pivotal in steering the diagnosis away from common possibilities and towards a rarer condition.

A New Perspective on Patient Management

The case highlights the importance of considering adnexal auto-amputation in the differential diagnosis of pelvic masses, especially in women presenting with pelvic pain or a history of adnexal torsion. The use of multimodal imaging, combining US, CT, and MRI, can aid in accurate diagnosis and guide appropriate management strategies. For symptomatic patients, laparoscopic removal of the detached adnexa may be warranted. However, in asymptomatic cases, expectant management might be a reasonable approach, avoiding unnecessary surgical intervention. Ultimately, a prospective diagnosis of adnexal auto-amputation could assist surgeons in patient management with a curative laparoscopy in symptomatic women, or potentially expectant management in young women who are asymptomatic or have unrelated symptoms.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.jogoh.2018.04.008, Alternate LINK

Title: Auto-Amputated Adnexa In A Young Woman: Multimodal Imaging To Rule In A Pelvic Rolling Stone

Subject: Obstetrics and Gynecology

Journal: Journal of Gynecology Obstetrics and Human Reproduction

Publisher: Elsevier BV

Authors: Vincent Durous, Laurent Milot, Jean-Noël Buy, Bruno Deval, Pascal Rousset

Published: 2019-06-01

Everything You Need To Know

What is adnexal auto-amputation?

Adnexal auto-amputation is a rare condition where the fallopian tube and/or ovary spontaneously separate from the body. While the term sounds alarming, it is not necessarily life-threatening. Diagnosis often involves imaging techniques, and management varies depending on symptoms.

What are the symptoms of auto-amputation of the adnexa, and what patient history led to the diagnosis in the case study?

The case study involved a 26-year-old woman who had deep dyspareunia and sporadic right pelvic pain. Initially, doctors suspected pelvic endometriosis. However, through a series of imaging tests, including transvaginal ultrasound, unenhanced low-dose pelvic CT, and MRI, the diagnosis of adnexal auto-amputation was determined.

How did multimodal imaging contribute to the diagnosis of adnexal auto-amputation in this case, and what specific details did each imaging technique reveal?

Multimodal imaging, specifically combining transvaginal ultrasound, CT scans, and MRI, played a crucial role. Transvaginal ultrasound revealed a mobile hypoechoic mass, CT scans confirmed a calcified mass without fat tissue, and MRI showed a mass unconnected to the genital tract, ultimately leading to the diagnosis of adnexal auto-amputation and ruling out other conditions like a dermoid cyst.

What are the recommended management strategies for adnexal auto-amputation, and how does the approach differ based on the patient's symptoms?

For symptomatic patients, laparoscopic removal of the detached adnexa may be necessary. However, for those without symptoms, expectant management, or observation, might be a reasonable approach to avoid unnecessary surgery. The decision depends on the individual case and symptoms.

What are the potential implications of overlooking adnexal auto-amputation in the differential diagnosis of pelvic masses, and how can a multimodal imaging approach improve patient outcomes?

Failing to consider adnexal auto-amputation in the differential diagnosis could lead to misdiagnosis and potentially unnecessary treatments. The multimodal imaging approach is critical to distinguish this rare condition from more common causes of pelvic pain and masses, such as endometriosis or dermoid cysts. Early and accurate diagnosis could lead to curative laparoscopy in symptomatic women, or expectant management in asymptomatic women, optimizing patient care and avoiding unnecessary interventions.