Uterine torsion in a non-pregnant woman with an ovarian cyst

Abstract

Uterine torsion is a rare surgical condition that may present with vague symptoms or severe lower abdominal pain. It occurs when the uterus rotates more than 45 degrees around its long axis. It may be challenging to diagnose due to its rarity and the non-specific nature of presentation. The condition is more common among women during their reproductive years, especially in those who are pregnant.We present a 54-year-old postmenopausal woman who presented with a 4-day history of severe abdominal pain associated with copious projectile bilious vomiting. She also had a 3-year history of gradual abdominal distension. A Computed Tomography scan showed a large complex abdominopelvic mass with associated small bowel obstruction and minimal bilateral pleural effusions. On exploratory laparotomy, a 30cm x 25cm right ovarian mass and a purplish-blue-coloured, dusky, 18-week-sized uterus, which was dextrorotated 180 degrees at the level of the isthmus, were noted. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was done for her. Uterine torsion can be considered as a differential for women with a huge ovarian mass presenting with sudden onset of severe abdominal pain. This will aid early intervention to save the uterus for those women with fertility wishes.