Twisting around an axis: A case report of uterine torsion
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Uterine torsion is a rare occurrence that often is diagnosed only with surgical intervention.The lack of significant imaging findings, vague symptoms, and low prevalence of uterine torsion lead to difficulty with identification and diagnosis.Uterine torsion is most commonly seen with a gravid uterus, especially if accompanied with uterine fibroids or pelvic adhesions. When non-gravid, its occurrence is rare.

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.

Therapeutic Intervention
Upon entry into the abdomen, one liter of blood was evacuated. The uterus was described as bulky, edematous, with multiple masses and visualization was initially limited due to sheer size and bleeding. However, upon packing of the bowel and evacuation of the hemoperitoneum, the uterus was noted to have levo-rotated and torsed upon itself at the level of the junction between the cervix and uterine corpus . Initial frozen pathology was reported as a ruptured, necrotic fibroid.

Hemostasis was eventually obtained, with additional blood given intra-operatively, and the patient was transferred to the post-operative unit in a stable condition. Post-operatively, the patient's course was complicated by an ileus but with eventual return of bowel function. The patient was discharged on post-operative day five.

In 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.

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