Abstract

The twisted uterus: A rare presentation of uterine torsion

Highlights

  • Uterine torsion is a rare gynecological emergency, defined as torsion of the uterus greater than 45° around its axis

  • Conservation of the uterus following torsion was possible in this case, giving the chance of fertility preservation

  • This report describes the case of uterine torsion secondary to a large pedunculated fibroid in a 34-year-old nulliparous woman

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Summary

INTRODUCTION

Uterine torsion is a rare gynecological emergency, defined as torsion of the uterus greater than 45° around its axis [1]. This report describes the case of uterine torsion secondary to a large pedunculated fibroid in a 34-year-old nulliparous woman. She had a known large pedunculated fibroid arising from the fundus, measuring 180 × 170 × 100 mm This fibroid had last been visualized with MRI 11 months previously during outpatient investigation for mild abdominal pain and pressure symptoms under the gynecology team. Given that she was clinically well, she was discharged home with a presumed diagnosis of fibroid degeneration and a follow up transvaginal ultrasound scan (TV-US) the day She represented to ED with worsening pain and vomiting, causing significant distress, agitation, and an inability to remain still. The fibroid was exteriorized and a myomectomy was performed This revealed torsion of the uterus and adnexae by 720° clockwise on the isthmus of the uterus, with evidence of congestion and edema (Figure 2). A repeat TV-US demonstrated a thin endometrium with normal vascularity in the cervix, but no vascularity above the cervix, nor in either ovary

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