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Case Reports
. 2014 May;13(2):145-9.
doi: 10.5114/pm.2014.42718. Epub 2014 May 21.

Torsion of the uterus with myomas in a postmenopausal woman - case study and review of the literature

Dobrosława Sikora-Szczęśniak  1 , Grzegorz Szczęśniak  2 , Tomasz Łęgowik  3 , Wacław Sikora  1
Affiliations
Case Reports

Torsion of the uterus with myomas in a postmenopausal woman - case study and review of the literature

Dobrosława Sikora-Szczęśniak et al. Prz Menopauzalny. 2014 May.

Abstract

Introduction: Torsion of the uterus is defined as a rotation of more than 45° around the long axis of the uterus; 2/3 of cases are dextrorotations. The extent of rotation usually ranges from 45° to 180°.

Objective: The purpose of the article was to present a case study of a postmenopausal woman with uterine torsion and myomas and to review the articles discussing the problem of rotated non-pregnant uterus.

Material and methods: The article analyses the course of an extremely uncommon pathology, i.e. uterine torsion in a 67-year-old patient. Laparotomy exposed the uterus with myomas and numerous hemorrhages, rotated by 180° to the right side, size of 350 × 300 × 200 mm and bilateral necrosis of the ovaries. Moreover, we present a review of articles discussing surgical management in case of rotated non-pregnant uterus.

Results and discussion: The patient was operated on by a team of gynecologists and surgeons. The uterus was derotated and total hysterectomy with salpingoophorectomy was performed. A fragment of the hepatic oval ligament was excised and periumbilical hernioplasty was performed. The patient was released home on the 10(th) day following the operation.

Conclusions: If women complain of pain located within the small pelvis and abdominal cavity it is necessary to remember that it might result from the torsion of reproductive organs which is an uncommon condition but poses a health or life threat to patients. Surgical treatment of uterine torsion is successful if promptly implemented; in certain cases it is even possible to spare the patient's fertility.

Keywords: surgical treatment; uterine myomas; uterine torsion.

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Figures

Fig. 1
Fig. 1
Phase without dye. Visible hemorrhagic changes
Fig. 2
Fig. 2
Venous phase – wide veins visible on the left side. Configuration of the upper part of the vagina: X-shaped, vaginal veins widened
Fig. 3
Fig. 3
Oppressed vessels of the right kidney
Fig. 4
Fig. 4
Bilateral adnexa located anteriorly to the rotated uterus. Areas of hemorrhages into the uterus and ovaries
Fig. 5
Fig. 5
Dissection of the uterus
Fig. 6
Fig. 6
The uterus was derotated, total hysterectomy was performed
See this image and copyright information in PMC

References

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