Emergency Surgical Treatment of a Large Pedunculated Subserosal Uterine Leiomyoma With Torsion: A Rare Cause of Acute Abdomen

Abstract

Torsion of pedunculated subserosal leiomyoma of the uterus is a rare cause of acute abdomen. A 27-year-old female patient with twisted subserosal pedunculated uterine leiomyoma misdiagnosed as an adnexal mass underwent laparotomy. The patient came to the Emergency Department of General Hospital of Trikala with symptoms of acute abdomen. Primarily, clinical-laboratory examination, transabdominal ultrasound, raised the suspicion of a twisted adnexal mass. Intraoperatively, a twisted pedunculated subserosal leiomyoma of the uterus was identified and myomectomy was performed. Histological examination of the surgical specimen confirmed the diagnosis. On the third postoperative day, our patient was discharged. This paper underscores the rarity of torsion of the uterine pedunculated subserosal leiomyoma and emphasizes the necessity of urgent surgical intervention. The challenges of preoperative diagnosis are highlighted, especially when modern diagnostic imaging modalities are unavailable.

Keywords: abdominal pain; case report; emergency surgical treatment; pedunculated subserosal leiomyoma; preoperative diagnosis; torsion.

Figure 1. Intraoperative image depicting torsion of pedunculated subserosal uterine leiomyoma

The presence of a long vascular pedicle (yellow arrow), combined with the large size of the tumor, significantly increases the risk of fibroid torsion

Figure 2. Histological image of twisted pedunculated subserosal uterine leiomyoma

A subcellular leiomyomatous tumor without atypia and mitoses, with collagen deposition and with dilated congested vessels as a result of torsion is depicted