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Complete Uterine Torsion, Non-Pregnant Woman, basrah, iraq
A 49 years nullipara lady with history of primary infertility for fifteen years, she had heavy menstrual bleeding over the last years causing anaemia. the patient presented with severe lower abdominal pain start in the sub-umbilical area and radiated to the genitalia ,with no response to analgesia.
On examination the patient was normotensive but there was tachycardia, on abdominal examination there was lower abdominal tenderness; no guarding with hard irregular mass of 22 weeks size. bimanual pelvic examination revealed severe vaginal bleeding associated with clot, bulky tender irregular shaped uterus of approximately 20–22 weeks in size with bilateral fullness in the adnexa.
Blood investigations revealed leucocytosis with a white blood cell (WBC) count of 12 x 109/l, bHCG titre was less than 2 µ/l with normal hepatic and renal function test. MRI and ultrasonography revealed multiple uterine fibroids, the largest being the subserous of 8 * 8.5 cm project from the posterior fundal wall with distorted uterine axis with possible uterine ischemia, as well as a cervical fibroid of 4.4 * 3cm and minimal amount of free fluid in the pouch of Douglas.
Urgent laparotomy was done under spinal anesthesia the abdominal wall was opened through Pfannenstiel incision. There was hemoperitoneum of approximately 500 ml with large, deformed uterus containing multiple subserosal fibroids. one of them was congested, and its feeding vessel was ruptured. the uterus was twisted about 360° at the level of the isthmus.
the uterus had re-twisted and total hysterectomy and bilateral salpingo-oophorectomy was performed.
Histopathological examination revealed a uterine size of 20 x 16 x 6 cm with multiple intramural and subserosal myoma, the largest of which measured 5 x 5 cm with foci of adenomyosis; there was no significant pathology in the ovaries and fallopian tubes.
the postoperative period passed smoothly, and the patient was discharged after two days
2. L.Raymond ,G.Jason,R.Benjamin,A.Sardar. Uterine torsion: review with critical considerations for the obstetrician and gynecologist.Translational Research in Anatomy.2020;21.
3. A. Nikolov, E. Tiufekchieva, R. Raicheva. Torsion of a nongravid leiomyomatous uterus,Akush. Ginekol. (Mosc.).2006; 45 (5): 49-51.
4. H. Matsumoto, T. Ohta, K. Nakahara, T. Kojimahara, H. Kurachi Torsion of a nongravid uterus with a large ovarian cyst: usefulness of contrast MR image.Gynecol. Obstet. Invest.2007; 63 (3): 163-165.
5. R. Sparic, B. Lazovic . Inevitable cesarean myomectomy following delivery through posterior hysterotomy in a case of uterine torsion.Med. Arch.2013; 67 (1) :75-76
6. S.K. Kim, J.E. Chung, S.W. Bai, J.Y. Kim, H.K. Kwon, K.H. Park, C.H. Song. Torsion of the pregnant uterus.Yonsei Med. J.2001; 42 (2): 267-269.
7. D. Sikora-Szczesniak, G. Szczesniak, T. Legowik, W. SikoraTorsion of the uterus with myomas in a postmenopausal woman - case study and review of the literature.Przeglad menopauzalny = Menopause review.2014; 13 (2) : 145-149.
8. A.M. Ramseyer, J.R. Whittington, V.A. Resendez, D.D. Whitcombe, E.F. Magann.Torsion in the gravid and nongravid uterus: a review of the literature of an uncommon diagnosis.Obstet. Gynecol. Surv.2020; 75 (4): 243-252.
9. W.K. Nicholson, C.C. Coulson, M.C. McCoy, R.C. Semelka Pelvic magnetic resonance imaging in the evaluation of uterine torsion.Obstet. Gynecol.1995; 85 (5 Pt 2): 888-890.
10. F.Y. Yap, R. Radin, H. Tchelepi.Torsion, infarction, and rupture of a nongravid uterus: a complication of a large ovarian cyst,Abdom Radiol (NY).2016; 41 (12) :2359-2363. 11.S.Y. Luk, J.L. Leung, M.L. Cheung, S. So, S.H. Fung, S.C. Cheng .Torsion of a nongravid myomatous uterus: radiological features and literature review Hong Kong Med. J.2010; 16 (4):304-306.