Van Swaay Annette, Garibay Jorge
Obstetrics and Gynecology, Saint Joseph Hospital, Denver, USA.
Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, USA.
Cureus. 2024 Nov 25;16(11):e74428. doi: 10.7759/cureus.74428. eCollection 2024 Nov.
Adnexal torsion is a well-recognized gynecologic emergency; however, uterine torsion is less well-known. The majority of uterine torsions occur in gravid uteri; torsion in postmenopausal patients is rare. We report a case of uterine and bilateral adnexal torsion in a postmenopausal woman due to a large leiomyoma. This patient presented to the emergency department with acute onset pelvic pain in the setting of a known pelvic mass. Imaging findings were significant for a large pelvic mass that differed in location when compared to prior imaging. In addition, the cervix had a "twisted" appearance on imaging. Overall these findings were suspicious for uterine torsion, and surgical management was planned. Operative findings were significant for 720-degree uterine torsion at the level of the lower uterine segment due to a large subserosal fibroid extending into the left broad ligament. Pathology was significant for confirmed leiomyoma measuring 25 cm, with edema and myxoid changes, uterus and bilateral ovaries with hemorrhage and congestion, all of which supported the diagnosis of uterine torsion, which also resulted in bilateral adnexal torsion. This case demonstrates an instance of uterine and bilateral adnexal torsion that was managed in a timely fashion. If surgical treatment is delayed, grave sequelae can occur. Consideration of concomitant uterine and adnexal torsion during an acute pelvic pain workup is crucial to ensure appropriate inpatient management, preoperative counseling, surgical consent, and patient safety.
附件扭转是一种广为人知的妇科急症；然而，子宫扭转却鲜为人知。大多数子宫扭转发生在妊娠子宫；绝经后患者发生扭转的情况罕见。我们报告一例绝经后妇女因巨大平滑肌瘤导致子宫及双侧附件扭转的病例。该患者因已知盆腔肿物，以急性发作的盆腔疼痛就诊于急诊科。影像学检查发现一个大的盆腔肿物，与之前的影像学检查相比位置不同。此外，宫颈在影像学上呈“扭曲”外观。总体而言，这些发现怀疑为子宫扭转，遂计划进行手术治疗。手术结果显示，由于一个延伸至左侧阔韧带的巨大浆膜下肌瘤，子宫下段发生了720度扭转。病理检查确诊为平滑肌瘤，大小为25 cm，伴有水肿和黏液样改变，子宫及双侧卵巢有出血和充血，所有这些均支持子宫扭转的诊断，同时也导致了双侧附件扭转。本病例展示了一例及时得到处理的子宫及双侧附件扭转情况。如果手术治疗延迟，可能会出现严重后果。在急性盆腔疼痛检查过程中考虑合并子宫和附件扭转，对于确保适当的住院治疗、术前咨询、手术同意和患者安全至关重要。
