Twisting around an axis: A case report of uterine torsion

Abstract

Introduction: A woman presenting with sudden, severe pelvic pain should prompt an evaluation for torsion, most commonly, ovarian torsion. Uterine torsion is rare, especially in a non-gravid uterus.

Case: A post-menopausal woman with known history of uterine leiomyomata presented with sudden, acute pain that was non-amenable to medication. Imaging demonstrated a significant increase in uterine size but was otherwise normal. Primary diagnoses included a degenerative fibroid, leiomyosarcoma, or pelvic thrombosis. Surgical intervention revealed a levo-rotated uterus. Final pathology demonstrated a leiomyosarcoma.

Conclusion: Pelvic organ torsion most often presents as sudden pain that is unrelieved by medication. Diagnosis is sometimes made with imaging and Doppler studies. Surgical intervention is often required. In a patient with a rapidly enlarging fibroid uterus with acute pain, one should consider a uterine torsion.

Keywords: Leiomyosarcoma; Torsion; Uterine torsion.

Fig. 1

Illustration demonstrating 180 degree levorotation of uterus at the utero-cervical junction with fundal, large necrotic fibroid.