Cological causes of acute abdomen include ectopic pregnancy, ovarian cysts, adnexal torsion, pelvic inflammatory disease, endometriosis or degenerating uterine fibroids. Adnexal torsion is caused by the rotation of the ovary, tube or both on their pedicle and is responsible for 3% surgical emergencies in women. overnight usa order viagra online It is usually associated with an ovarian tumour, which is mostly benign; the commonest being a dermoid cyst. does viagra work young women 8 although rare, torsion of malignant ovarian tumour has been reported in the literature. buy viagra generic A review of 20 years experience regarding torsion of malignant ovarian tumours in childhood and adolescence at tertiary care referral institution at serbia showed 5 cases of malignant neoplasm out of 23 torsioned masses. Four were germ cell tumours and one was sex cord stromal tumour. viagra for young men how does it work 9 in another reported series, 22% cases of adnexal torsion were due to malignant neoplasms in postmenopausal women. viagra movie jake 10 however, to the best of our knowledge, torsion of krukenberg tumour has not been reported in the literature. Other predisposing factors for torsion of ovarian tumours are pregnancy, moderate size of tumour with a long pedicle which was not present in this presented case. viagra for cheap Therefore torsion of this tumour was a chance finding. generic viagra canada Krukenberg tumour carries a poor prognosis without well established guideline for evaluation and management. Buy viagra online no rx Kim hk & heo ds11 in their study on the evaluation of prognostic factors reported median survival of 7. buy viagra on line cheap 7 months. viagra without a doctor prescription The only favourable prognostic factors affecting survival were limited disease extent and the absence of residual disease after treatment. Viagra price tesco The patient\'s age, size of ovarian tumour, initial stage of gastric adeno-carcinoma and relapse free interval do not have any impact on patient survival. 11 literature review also pointed out other adverse prognostic factors like elevated serum ca-125 levels (>75 iu/ml), stomach as the primary site of tumour and the diagnosis of primary lesion after the emergence of metastatic ovarian lesion. buy viagra without prescription 1,12,13 we were expecting short survival in the present case for several reasons. cheap viagra overnight Firstly the primary tumour was gastric in origin and was diagnosed after ovarian lesion, secondly she had raised serum ca-125 levels and thirdly the disease was wide spread at the time of surgery involving adjacent pelvic and abdominal structures making resection impossible. buy viagra wholesale Conclusion although a rare clinical entity, the possibility of krukenberg tumour should always be kept in mind while evaluating ovarian tumours in order to avoid potential hazards in the diagnosis and management of this deadly disease. viagra for young men how does it work The dictum of thorough abdominal examination during pelvic surgery should not be forgotten. 2 bathtubs viagra commercial References 1. Al-agha om, nicastri a d. viagra use after heart attack An in-depth at krukenberg tumour: an overview. viagra buying Arch pathol lab med 2006; 130: 1725-30. viagra for young men how does it work 2. Iltaf s,. viagra side effects ear