Oda Hiroko, Yamada Youko, Uehara Yuriko, Ohno Tamami, Hoya Mari, Sassa Mariko, Mishima Misako
Department of Obstetrics and Gynecology, Kawakita General Hospital, Tokyo, Japan.
Case Rep Obstet Gynecol. 2020 Oct 20;2020:8857300. doi: 10.1155/2020/8857300. eCollection 2020.
Uterine torsion is extremely rare in postmenopausal women. Total ischemia of the uterus may cause life-threatening conditions; hence, accurate diagnosis and surgical intervention are crucial. However, preoperative diagnosis is often challenging due to nonspecific clinical features and laboratory findings. We report a case of uterine torsion in a 73-year-old woman who presented with mild but gradually worsening intermittent abdominal pain. During a 5-day observation, repeated blood exams showed elevating serum muscle enzyme levels, lactate dehydrogenase (LDH), and creatinine kinase (CPK), in addition to nonspecific signs of inflammation. Computed tomography (CT) scans were obtained before and after the worsening of symptoms, which revealed changes in size and position of the enlarged uterus with a large leiomyoma, even within a 5-day interval. Based on these findings, the preoperative diagnosis was uterine torsion. Emergency surgery revealed a 540-degree torsion of the uterus at the cervix and uterine body junction. Total hysterectomy and bilateral salpingo-oophorectomy were performed. Plasma muscle enzyme levels normalized after surgery, and the patient recovered without complications. In conclusion, uterine torsion should be considered during differential diagnosis in elderly women with large leiomyoma, even when symptoms are mild. Elevating plasma muscle enzymes may be an indication of uterine torsion; hence, repeated laboratory works and CT scanning should be performed when symptoms progress. Comparison of CT images, taken before and after the worsening of symptoms, may also be relevant for diagnosis. Since uterine torsion may cause rapid deterioration and become life-threatening, early diagnosis and surgical intervention are crucial to avoid serious complications.
子宫扭转在绝经后女性中极为罕见。子宫完全缺血可能导致危及生命的状况；因此，准确诊断和手术干预至关重要。然而，由于临床特征和实验室检查结果不具特异性，术前诊断往往具有挑战性。我们报告一例73岁女性子宫扭转病例，该患者表现为轻度但逐渐加重的间歇性腹痛。在为期5天的观察期间，反复血液检查显示血清肌酶水平升高，包括乳酸脱氢酶（LDH）和肌酸激酶（CPK），此外还有非特异性炎症迹象。在症状加重前后均进行了计算机断层扫描（CT），结果显示即使在5天的间隔内，子宫伴有大的平滑肌瘤，其大小和位置也发生了变化。基于这些发现，术前诊断为子宫扭转。急诊手术显示子宫在宫颈和子宫体交界处扭转了540度。进行了全子宫切除术和双侧输卵管卵巢切除术。术后血浆肌酶水平恢复正常，患者康复且无并发症。总之，对于患有大平滑肌瘤的老年女性，即使症状轻微，在鉴别诊断时也应考虑子宫扭转。血浆肌酶升高可能提示子宫扭转；因此，症状进展时应反复进行实验室检查和CT扫描。比较症状加重前后的CT图像也可能有助于诊断。由于子宫扭转可能导致病情迅速恶化并危及生命，早期诊断和手术干预对于避免严重并发症至关重要。
