Sudden Onset Of Abdominal Pain Research Articles

An unusual cause of acute mesenteric ischaemia

A 50-year-old woman, smoker, with a body mass index of 29 kg/m2, presented to the emergency department with a history of sudden-onset abdominal pain localised to the left hypochondrium and...

Rare complication of subacute renal artery intramural haematoma after renal artery stenting: a case report.

BackgroundRenal artery intramural haematoma (IMH) is a rare cause of renal artery obstruction after stenting. Diagnosis and treatment are difficult as there are only a few cases reported.Case summaryWe present the case of sudden-onset abdominal pain and non-functional kidney 3 days after renal artery stent implantation. Subacute luminal narrowing of the renal artery was initially diagnosed using computed tomography angiography and renal artery angiography, and a final diagnosis of subacute renal artery IMH was made using intravascular ultrasound (IVUS). Subsequently, the patient was treated with percutaneous transluminal angioplasty from far to near and another stent implantation. At the third month follow-up, blood pressure and renal function were normal.DiscussionThis case suggests that IVUS could be useful for qualifying and treating the subacute renal artery IMH.

Necrosis of the small intestine leading to a diagnosis of polyarteritis nodosa: a case report

BackgroundPolyarteritis nodosa is a disease that presents with necrotizing vasculitis in small and medium-sized arteries. It may occur in various organs, but approximately half of cases have gastrointestinal involvement. Prognosis is not favorable once organ dysfunction begins as evidenced by gastrointestinal symptoms; thus, treatment with steroids should be promptly initiated. We report the case of a patient who presented with necrosis of the small intestine, which was pathologically diagnosed as polyarteritis nodosa and treated successfully with steroids.Case presentationAn 18-year-old Japanese woman reported a sudden onset of abdominal pain and vomiting that led her to visit our emergency department, where she was evaluated by a physician. On physical examination, tenderness to palpation in the upper umbilical region was noted, and diagnostic imaging with computed tomography showed emphysema of the wall of her small intestine. She was diagnosed as having necrosis of the small intestine requiring urgent surgery. No strangulations were noted intraoperatively but approximately 20 cm of her small intestine was necrotized. The surrounding arteries were examined and no palpable pulse was observed; therefore, segmentectomy of the necrotized regions was performed. Pathological findings revealed active vasculitis with fibrinoid necrosis, as well as destruction, fibrogenesis, and luminal stenosis of the elastic lamina found in the muscular arteries. A diagnosis of polyarteritis nodosa was confirmed as the cause of the necrosis of her small intestine. No recurrence of polyarteritis nodosa symptoms was observed when she was administered 40 mg of prednisolone daily.ConclusionIn cases of idiopathic intestinal necrosis or perforation, systemic diseases such as polyarteritis nodosa should be considered in the differential diagnosis.

LAPAROSCOPIC REPAIR OF PERFORATED DUODENAL ULCER PATCH VERSUS CONVENTIONAL SURGERY

Introduction: For many surgeries for duodenal ulcer Laparoscopic repair has become gold standard for many elective procedures such as ant reflux procedures, laparoscopic cholecystectomy and in colorectal surgery. Although in the emergency setting such as in the management of perforated duodenal ulcer Laparoscopic repair has been slow and limited. Since 1990, for the treatment of perforated peptic ulcer Laparoscopic repair has been used which has been widely accepted as an effective method. Duodenal ulcer is defined as a peptic ulcer which develops in the first part of the small intestine called duodenum and usually present as a perforation of acute abdomen. In perforated duodenal symptoms as severe and sudden onset abdominal pain that is worse in right upper quadrant and epigastrium and usually followed by nausea and vomiting. In this situation there is rapid generalization of pain and in examination shows peritonitis with lack of bowel sounds. Aim: The main objective of this study is to evaluate outcome of laparoscopic surgery in comparison with conventional surgery. Material and methods: All the patients with clinically diagnosed with perforated duodenal ulcers presenting within 24 hours of symptoms and undergoing surgery were included during the study period. Total 50 patients were included with age group 15-65 years. All the patients with perforated duodenal ulcers were included which go through either conventional open or laparoscopic without omental patch repair. Result: Total 50 patients were included in these studies which were divided into two group with 25 patients in each group as laparoscopic duodenal perforation repair group and conventional open repair group. Mean duration of operation (in minutes) was 105.4±10.4 in laparoscopic duodenal perforation repair group whereas mean duration of operation (in minutes) was 67.3±8.6 in conventional open repair group. Mean duration of number of doses of analgesics required in laparoscopic group and conventional open group as 9.5±1.7 and 17.2± 3.1 respectively. Out of 25 patients in each group of laparoscopic duodenal perforation repair group and the conventional open repair group the outcome were noted with their post operative complication as shown in table no 5 below. In Post-operative complications 21(84%) patients in laparoscopic duodenal perforation repair group and 14(56%) patients in conventional open repair group had no complications. 4 (16%) patients in the laparoscopic duodenal perforation repair group and 2(8%) patients in conventional open repair group showed Post-operative complications as chest infection. In the conventional open repair group patients present with wound dehiscence and wound infection and Wound dehiscence and chest infection were 4(16%) and 5(20%) respectively whereas nil in Laparoscopic duodenal perforation repair group. Conclusion: Duodenal ulcer perforation is a life-threatening emergency which required urgent management for the patients. Due to the advance in duodenal ulcer perforation closure by laparoscopy it becomes popular and favorite choice. With certain criteria, laparoscopic closure of perforated duodenal ulcer is safe and effective though it was associated with longer operating time and had no impact on the outcome. Hence laparoscopic closure was better in comparison to open repair for the earlier returns to normal daily activities.
 Keywords: Duodenal ulcer, Laparoscopic repair, Post-operative analgesia, conventional surgery

Anticoagulants is a risk factor for spontaneous rupture and hemorrhage of gallbladder: a case report and literature review

BackgroundThe spontaneous rupture of the gallbladder is extremely rare, majority of ruptures occur secondary to traumatic injuries. Here, we report a case of spontaneous rupture of the gallbladder with probably cause of oral anticoagulants.Case presentationA 51-year-old woman presented to the emergency room with sudden-onset severe abdominal pain, as well as hypotension and low level of hemoglobin. Abdominal computed tomography (CT) scan showed a 2.5 cm filling defect and discontinuity in the wall of the gallbladder body, and a massive hematocele in the abdominal cavity. Past medical history was significant for hypertension and had been taking daily aspirin for the past three years because of interventional surgery for cerebral aneurysms, but no history of recent abdominal trauma or past episodes of biliary colic. The patient underwent an urgent laparoscopic abdominal exploration and the gallbladder was removed. The pathology just showed chronic cholecystitis and the patient recovered well.ConclusionLong-term use of anticoagulants may increase the risk of gallbladder rupture and hemorrhage, which is a lethal condition. Rapid diagnosis and timely surgical intervention are the most important measures to treat the patient.

Splenic Rupture Secondary to Vascular Ehlers-Danlos Syndrome Managed by Coil Embolization of the Splenic Artery.

Aim Atraumatic splenic rupture is uncommon and life-threatening. It may be related to underlying pathology and be the initial manifestation of the condition. Vascular Ehlers–Danlos syndrome (V-EDS) is a rare autosomal dominant collagen vascular disorder, associated with vessel fragility and rupture. We describe a child presenting with splenic rupture managed by embolization of the splenic artery. She was subsequently diagnosed with V-EDS. Case Description A 11-year-old girl with thalassemia trait presented with sudden onset of abdominal pain and hypovolemic shock. There was no history of trauma. Following resuscitation, abdominal computed tomography showed hemoperitoneum and active splenic arterial extravasation. Angiography demonstrated four bleeding points, from irregular vessels supplying the upper two-thirds of the spleen. These were not amenable to supraselective embolization. Therefore, coil embolization of the main splenic artery was performed, with no splenic supply seen on the postembolization angiogram. Her postoperative recovery was complicated by pancreatitis secondary to partial ischemia of the pancreatic tail. Subsequent extensive investigations excluded hematological, myeloproliferative, and infective causes for her splenic rupture. A safeguarding investigation was completed, with no pertinent factors identified. Findings of thin skin, abnormal bruising, and hypermobile joints raised a clinical suspicion of a connective tissue disorder. Genetic testing revealed a de novo mutation of the COL3A1 gene. Conclusions There are only four reports of V-EDS causing splenic rupture in the literature to date. These patients were all adults and only one had not previously been diagnosed with V-EDS. All underwent splenectomy. While V-EDS presenting with abdominal visceral rupture in children has been reported, this is the first report of a child with V-EDS presenting with splenic rupture. It is the only case of splenic rupture secondary to V-EDS that has been managed minimally invasively by embolization.

Unusual cause of intestinal perforation during induction chemotherapy in acute myeloid leukemia

Primary intestinal aspergillosis is a rare but serious infectious complication with a high morbidity and mortality in immunocompromised patients. We report a case of 47-year old male diagnosed with acute myeloid leukaemia and started on induction chemotherapy. On day 18 of chemotherapy, he presented with an acute abdomen and underwent emergency exploratory laparotomy. Histopathological specimen revealed transmural necrosis with fungal hyphae due to aspergillosis and voriconazole was started. Serum galactomannan test done was negative. In the post-induction chemotherapy, he attained complete remission and received three cycles of consolidation with high-dose cytarabine. With this case, we would like to emphasize that early recognition of primary intestinal aspergillosis is of the utmost importance because of its fulminant clinical course. It should be included in the differential diagnosis of neutropenic patients with sudden onset abdominal pain and ongoing fever, even in the absence of a positive serum galactomannan.

Persistent omental trophoblastic implantation following salpingostomy, salpingectomy and methotrexate for ectopic pregnancy: A case report

2% of all pregnancies are ectopic. Optimal surgical management is currently salpingectomy over salpingostomy, secondary to the risks of persistent trophoblastic tissue or omental implants (15%). However, rare cases of omental trophoblastic implants following laparoscopic salpingectomy have been noted in the literature. Current practice dictates that serial determinations of human chorionic gonadotropin (beta-hCG) levels after salpingectomy are not required, as it is considered a definitive treatment. However, given that these cases are hard to interpret through ultrasound and are almost always detected via sudden-onset abdominal pain and acute haemoperitoneum (33%), an argument can be made for post-operative beta-hCG assessment.

A Reflection on the Use of Enoxaparin Based on Three Case Reports.

Enoxaparin is indicated for the treatment or prevention of many clinical disorders including deep vein thromboembolism, atrial fibrillation and mechanical valve thrombosis. It is one of the most commonly prescribed drugs in hospitals. However, haemorrhagic complications can occur, particularly in the elderly, patients with renal function impairment and patients with a very high or very low body weight. The authors describe the cases of three patients who had one or more risk factors for haemorrhagic complications, such as abdominal haematomas. The clinical presentation was similar in all three cases, with sudden-onset abdominal pain, an altered state of consciousness and hypotension. In all cases, investigation showed acute anaemia and large abdominal haematomas on imaging studies. A conservative approach was taken in the three patients, with suspension and reversal of anticoagulation, fluid resuscitation and red blood cell transfusion. Haemodynamic stability was achieved in two of the patients, but the third patient died.The authors consider it is important to present these case reports because of the widespread use of enoxaparin, and the need for rigorous dose adjustment for renal function variations and body weight. We hope this article raises awareness of haemorrhagic complications in high-risk groups and propose protocols are introduced for dose adjustment and monitoring the efficacy of enoxaparin.LEARNING POINTSClinicians should consider the possibility of enoxaparin-associated haemorrhagic complications in high-risk groups.Prompt identification and treatment of the haemorrhagic disorder can improve outcome.Correct dosing with anti-Xa in high-risk populations, such as the elderly, those with abnormal renal function and those with extremely high or low body weight, may be helpful in patients anticoagulated with enoxaparin.

Epidemic hysteria following the National School Deworming Day, Zamboanga Peninsula, Philippines, 2015.

IntroductionIn July 2015, the Philippines conducted a school-based mass drug administration using albendazole for soil-transmitted helminths infection. Reports of adverse events were subsequently made through the event-based surveillance system, mostly from the Zamboanga Peninsula on the island of Mindanao. A team from the Epidemiology Bureau investigated the reports of adverse events following mass drug administration (AEFMDA).MethodsFive schools were identified for the investigation which comprised an unmatched case-control study, key informant interviews and laboratory examinations. AEFMDA cases were students who had sudden onset of abdominal pain, vomiting, diarrhoea, loss of consciousness, headache or dizziness within 24 hours after intake of deworming tablet; controls were healthy students who did not develop signs and symptoms after deworming.ResultsMost (85%) of the 7313 AEFMDA cases reported nationwide were from Zamboanga Peninsula. Most reports were made after rumours of deaths following deworming and of the use of expired drug were spread through the region. Many parents sent their children to hospital, even if asymptomatic. The case-control study found that being an AEFMDA case was associated with no history of previous deworming (odds ratio = 4.08, 95% confidence interval: 1.77–9.42).DiscussionThe investigation concluded that epidemic hysteria was the cause of the increased number of AEFMDA cases in the Zamboanga Peninsula. The false information, aggravated by social media, caused panic and an increase in reporting. Some cases had no history of deworming, and they may not have been aware that albendazole is safe and that side-effects are expected. Risk communication before, during and after future national deworming programmes are recommended to prevent unnecessary reporting of AEFMDA.

A Rare Case of Bevacizumab and Radiation-Induced Ischemic Bowel Injury

Ischemic colitis is a poorly documented side effect of the combination of palliative radiation and targeted therapy with Bevacizumab, a recombinant and humanized monoclonal antibody against the vascular endothelial growth factor receptor.1 We present a case of acute onset of ischemic colitis in a patient with prior pelvic irradiation undergoing treatment of metastatic rectal adenocarcinoma with Bevacizumab. A 68 y/o male with microsatellite stable, KRAS-mutated Stage IVB Rectal Adenocarcinoma status post 3 months of fluorouracil, oxaliplatin, folinic acid, abdominal perineal resection with ileo-colonic anastomosis with end colostomy, and palliative radiation to pelvis and spine presented with abdominal pain and bright red blood in his ostomy bag. Hemoglobin was 5.6 g/dL on admission, with appropriate response after transfusion. Recent endoscopy showed monlial esophagitis and non-bleeding erosive gastropathy. Colonoscopy 1 year prior showed multiple benign polyps. He underwent colonoscopy via colostomy, which was remarkable for both a continuous area of non-bleeding ulcerated mucosa and a segmental area of severely friable mucosa within the distal colon, neither with stigmata of recent bleeding. Histopathology demonstrated severely active colitis with ulceration. Colorectal surgery recommended no acute surgical intervention given his poor prognosis. Conventional therapy for treatment of metastatic colorectal cancer includes a fluoropyrimidine-based therapy with or without the use of targeted therapy and/or palliative radiation. Bevacizumab inhibits tumor neovascularization, which has proven beneficial when treating solid tumors by restricting tumor growth and metastatic ability.1 Radiation amplifies this effect by free radical formation, which promotes cell death. Results of a retrospective study looking at 33 patients undergoing therapy with Bevacizumab and prior radiation showed a 9% incidence of severe bowel complications, including acute ischemic colitis and bowel perforation.2 Ischemic colitis, a rare and minimally reported risk of therapy with Bevacizumab and radiation, should be considered in patients presenting with sudden onset of abdominal pain and hematochezia.1487_A Figure 1. Previously normal appearing descending colon1487_B Figure 2. Friability with absence of bleeding in distal colon1487_C Figure 3. Ulceration of distal colon

A rare case of spontaneous common bile duct perforation

Spontaneous perforation of the common bile duct (CBD) in adults is an extremely rare complication of gallstones. It is challenging to establish the diagnosis pre-operatively however with increasing utility of computer tomography, there may be subtle features visualized. We describe a case of a 35 year old Indian male who presented with an acute abdomen and was found to have biliary peritonitis secondary to a spontaneous CBD perforation. Mr JJ presented with sudden onset of abdominal pain associated with vomiting and diarrhea. He had generalized abdominal peritonitis. Initial erect chest x-ray was unremarkable for free air under the diaphragm, hence a CT was performed which revealed moderate amounts of free fluid around the 2nd part of the duodenum extending along the anterior para-renal space into the pelvis, with a 4mm distal CBD stone resulting in mild upstream dilatation. The gallbladder was decompressed and the CBD wall was not well visualized in the mid-portion, raising the possibility of perforation. An exploratory laparotomy revealed generalized biliary peritonitis secondary to a 2 cm CBD perforation just distal to the cystic duct junction. Choledochoscopy confirmed the small 4mm distal CBD stone which was advanced successfully through the ampulla into the duodenum. He underwent abdominal lavage, cholecystectomy, choledochectomy and a roux-en-Y hepatico-jejunostomy reconstruction. His recovery was uneventful. Histology confirmed focal transmural necrosis of the bile duct with fibrosis and micro-abscess formation. Clinicians should be aware that whilst spontaneous extrahepatic bile duct perforations are rare, it is important as timely diagnosis can be life-saving.

Perforated Diverticulitis of the Transverse Colon: An Unexpected Cause of Abdominal Pain During Preoperative Bowel Preparation

Diverticulitis affecting the transverse colon is uncommon, with perforation being exceptionally rare. It is not usually considered in the differential diagnosis of a patient with acute abdominal pain. We report a case of nonspecific abdominal pain secondary to a perforated diverticulum in the transverse colon during preoperative bowel preparation. A 74-year-old Caucasian female had sudden onset abdominal pain and nausea with routine bowel preparation. This undifferentiated acute abdomen was suggestive of a bowel perforation, which was later confirmed by a computed tomography scan. Surgical exploration determined the location of the perforation in the transverse colon. We report an unusual presentation of preoperative abdominal pain during routine bowel preparation. It is extraordinarily uncommon to see rupture of a transverse colon diverticulum in a patient with sigmoid involvement, and bowel preparation as a cause of rupture has not been previously documented. Because perforation of a transverse colon diverticulum generally has a nonspecific clinical presentation, it should be considered in the differential diagnosis for a patient with known diverticular disease who has acute onset abdominal pain and signs of peritonism.

English

Small bowel diverticulitis is a rare condition that is often excluded in the differential diagnosis of acute abdomen. We herein present two cases of patients with small bowel diverticulitis who presented with acute abdomen. First case was a 72-year-old lady who presented to emergency with 2 days of sudden-onset worsening generalized abdominal pain. The computed tomography (CT) revealed a segment of abnormally thickened jejunum with marked adjacent inflammatory mesenteric fat stranding and adjacent extraluminal gas locules, in keeping with complicating perforation. The patient was subsequently taken to the operating theater for an emergency laparotomy which revealed a contained perforation of the proximal jejunum secondary to a ruptured diverticulum. 20 cm of proximal jejunum containing the perforation was resected. The patient recovered uneventfully and was discharged day 7 following the operation. Second case was a 78-year-old lady who presented with 12 h of sudden-onset right-sided abdominal pain. The CT revealed the presence of multiple diverticula in the jejunum associated with diffuse wall thickening and marked peridiverticular inflammatory changes. This was most in keeping with small bowel diverticulitis, however, there was no definite extraluminal gas to suggest any evidence of perforation. The patient was managed conservatively with intravenous antibiotics and bowel rest. The patient’s pain improved with improving inflammatory markers during the hospital stay. The patient was discharged day 4 following the admission. We believe that there is a need to devise a comprehensive treatment guidelines specific for small bowel diverticulitis. In the meantime, it is deemed safe to conservatively manage uncomplicated cases without perforation. Key words: Intestine, small, abnormalities, abdomen, acute, diverticulosis, colonic, diverticulitis, colonic, clinical protocols, tomography, computed.

Laparoscopic treatment of intestinal obstruction due to a vitelline vascular remnant and simultaneous appendicitis: a case report

BackgroundThe presence of a vitelline vascular remnant is rare, and definitive preoperative diagnosis is difficult. We herein describe a case of intestinal obstruction caused by a vitelline vascular remnant with mild chronic appendicitis successfully diagnosed and treated with laparoscopic surgery.Case presentationA 14-year-old male was admitted to our hospital with sudden-onset right lower abdominal pain and vomiting. A blood test on admission revealed slight leukocytosis. Computed tomography scan showed that the appendiceal wall was enhanced and thickened. Although the ileum was slightly dilated and ascites was present at the recto-vesical pouch, these were thought to be inflammatory changes secondary to appendicitis. Laparoscopic surgery was performed using three trocars. Strangulated small bowel obstruction caused by a band connecting the right medial umbilical fold to the ileal mesentery was found intraoperatively. After reduction, neither ischemic change of the small intestine nor Meckel’s diverticulum was detected. The appendix was slightly inflamed, and serous ascites was present at the recto-vesical pouch; therefore, appendectomy was also performed. The patient was discharged on postoperative day 4 without complications. Pathological examination revealed that the band consisted of blood vessels, and it was diagnosed as a vitelline vascular remnant. The appendix included fecal stones and showed chronic inflammatory change histologically; the patient was thus diagnosed with chronic appendicitis.ConclusionsDefinitive preoperative diagnosis of a vitelline vascular remnant, especially with coexisting appendicitis, might be difficult. Laparoscopic surgery might be useful for patients who demonstrate unusual symptoms because it allows for simultaneous diagnosis and treatment.

Uretero-fallopian fistula after hysteroscopy fallopian tube embolization: a case report

BackgroundUretero-fallopian fistula (UFF) is a very rare surgery complication which usually happens after surgeries of fallopian tube or ureter. There has been no report of interventional operations of fallopian tube causing UFF.Case presentationA 41-year-old female received fallopian tube embolization for birth control. After that she noticed “clear vaginal discharge”. She neglected that symptom for 7 years, until a sudden onset of abdominal pain brought her to the ER. Retrograde ureterogram confirmed UFF and revealed severe hydronephrosis of the left kidney. She received left nephrectomy afterwards and recovered well, with no urine leakage from her vagina.ConclusionUFF could be caused by interventional operations of fallopian tube, and could lead to severe consequences. The application of fallopian tube embolization should be carefully controlled.

A RARE CAUSE OF SMALL BOWEL OBSTRUCTION: GALL STONE ILEUS – A RADIOLOGICAL CASE REPORT WITH REVIEW OF LITERATURE

Small bowel obstruction (SBO) is a common clinical condition. The effective management depends on an early and accurate diagnosis. Gall stone ileus is a rare cause of mechanical small bowel obstruction and contributes to 1-4% of all cases of mechanical small bowel obstruction. The incidence is typically seen in elderly females. The diagnosis is often difficult and a previous history of gall stone disease helps in reaching the correct diagnosis. Surgical management is the preferred modality for treatment. We are reporting a case of Gallstone ileus diagnosed recently in our hospital. A 54 year old elderly female presented with sudden onset abdominal pain with recurrent vomiting for one day. A Plain radiograph of abdomen done in Emergency department suggested findings of small bowel obstruction. It was followed by an urgent ultrasound of abdomen which showed collapsed Gall bladder, pneumobilia and dilated non-peristaltic small bowel loops. Finally a contrast enhanced CT scan of abdomen was done and it showed air within in the biliary tree and within the collapsed Gall bladder. The Small bowel loops were dilated to the upper border of a large radiolucent intraluminal filling defect in the distal ileum. It also showed loss of clear interface between Gall bladder and second part of duodenum suggesting a possibility of Cholecystoenteric fistula. The patient underwent an urgent laparotomy with enterolithotomy. A 35 x 35mm calculus was impacted in the distal ileum. A fistulous communication was noticed between Gall bladder and the second part of duodenum which was repaired along with cholecystectomy.

Sugammadex and amino acid infusion can contribute to safe anesthetic management of variegate porphyria

BackgroundVariegate porphyria (VP) is an inherited type of porphyria characterized by cutaneous manifestations and/or acute neurovisceral attacks. We report successful anesthetic management of VP.Case presentationA 66-year-old woman with VP was scheduled to undergo distal pancreatectomy for pancreatic cancer. Medical history was unremarkable except for sudden onset of abdominal pain that occurred every few months, possibly due to VP. There was no abnormality in laboratory data except for a mild increase in creatinine levels. General anesthesia was induced and maintained with total intravenous anesthesia using propofol, remifentanil, and rocuronium. Blood glucose levels were measured every hour and glucose administered to prevent hypoglycemia. Amino acids were also infused to treat hypothermia. Upon completion of distal pancreatectomy, sugammadex was administered to reverse neuromuscular blockade. She was neurologically intact and discharged on postoperative day 15 with no acute attack.ConclusionsSugammadex and amino acids can be used safely in patients with VP.

TCTAP C-174 To Revascularize or to Embolize, That Is the Question

### Patient Initials or Identifier Number CH ### Relevant Clinical History and Physical Exam The 53 year-old man had underlying disease of hypertension without medical control. He suffered from sudden onset of abdominal pain after having lunch on Feb 17th, 2017. The pain was located at left upper

Torsion of pedunculated subserous uterine leiomyoma: A rare complication of a common disease

ObjectiveTo evaluate the clinical presentations, diagnosis, management, and outcomes of torsion of the pedunculated subserous uterine leiomyoma. Materials and methodsWe retrospectively reviewed medical records of patients with subserous uterine leiomyomas undergoing surgeries at National Taiwan University Hospital from January 2001 to December 2015. ResultsFive cases of torsion of pedunculated subserous uterine leiomyoma were identified. All presented with sudden onset abdominal pain. Two patients received emergent surgeries, the other three cases received scheduled surgeries. The postoperative courses of these five women were uneventful without sequelae. ConclusionsTorsion of pedunculated subserous uterine leiomyoma is rare. Accurately diagnosing it prior to surgery is a major challenge. It should be one of the differential diagnosis in patients with uterine leiomyoma presenting with acute abdomen.