Torsion of a Large Myomatous Uterus Associated with Progressive Renal Failure and Paralytic Ileus in an 86-Year-Old Woman

Abstract

Uterine torsion of a nongravid uterus is rare, and proper diagnosis is challenging. Herein, we report a case of torsion of a large myomatous uterus in an 86-year-old woman who was presented with progressive renal failure and paralytic ileus. She was presented with abdominal discomfort, loss of appetite, and oliguria. A large myomatous uterus with broad calcification was identified when she underwent surgery to repair an umbilical hernia one year before the symptoms developed. Computed tomography revealed that one year later, the myomatous uterus significantly increased in size and the calcified lesion of the fibroid was largely displaced. She was also presented with paralytic ileus, and her general condition progressively worsened. Her serum creatinine levels were increased (3.5 mg/dL) and hemoglobin levels were low (8.5 g/dL). Emergency laparotomy revealed that the uterus was rotated 360 degrees clockwise at the level of the isthmus. The uterus was discolored, appearing dark red, and accompanied by broad congestion, and the cervix was elongated. The patient's renal function and ileus recovered after a hysterectomy. In conclusion, torsion of a large myomatous uterus could become life-threatening in an oldest-old woman, and early release of the torsion is necessary to avoid serious complications.

Figure 1

Computed tomography (CT) findings of the myomatous uterus. (a) Coronal section of the abdomen one year before the uterine torsion. The myomatous uterus and calcified portion are observed. (b) Coronal section of the abdomen at the time of uterine torsion. The myomatous uterus significantly increased in size, and the calcified lesion was displaced. (c) Three-dimensional reconstruction images of the lower abdomen one year before the uterine torsion. (d) Three-dimensional reconstruction images of the lower abdomen at the time of uterine torsion. The calcified area inside the uterus was largely displaced.

Figure 2

CT findings of the cervix. (a) Axial section of the lower abdomen one year before the uterine torsion. (b) Axial section of the lower abdomen at the time of uterine torsion. The cervix was elongated and moved upward compared with its position one year before (arrow).

Figure 3

Operative findings of the twisted myomatous uterus. (a) The myomatous uterus was rotated 360 degrees clockwise on the long axis at the level of the isthmus. The uterine surface was discolored, appearing dark red because of the congestion. (b) After releasing the torsion, the uterine color turned red and the lower uterine segment was observed. (c) The resected myomatous uterus and bilateral adnexa. The surface of the uterus was dark red and the cervix was significantly elongated. (d) A cross-section of the uterus revealed the accumulation of clotting blood inside the uterus.