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Case Report
The twisted uterus: A rare presentation of uterine torsion
1 Obstetrics and Gynaecology Trainee, Department of Obstetrics and Gynaecology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
2 Medical Student, Department of Life Sciences & Medicine, King’s College London, London WC2R 2LS, UK
3 Consultant, Early Pregnancy and Gynaecology Unit, Department of Gynaecology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
4 Obstetrics and Gynaecology Fellow, Early Pregnancy and Gynaecology Unit, Department of Gynaecology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
5 Consultant, Department of Radiology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
Address correspondence to:
Madeleine Trowsdale Stannard
Department of Obstetrics and Gynaecology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH,
UK
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Article ID: 100106Z08MS2022
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How to cite this article
Trowsdale Stannard M, Whittaker M, Abdul Aziz N, Cloke B, Diab Y, Gaughran J, Jacques A, Holland T, Amin T. The twisted uterus: A rare presentation of uterine torsion. J Case Rep Images Obstet Gynecol 2022;8:100106Z08MS2022.ABSTRACT
Introduction: Uterine torsion is a rare gynecological emergency, defined as torsion of the uterus greater than 45° around its axis. Case reports describe torsion either in the gravid uterus or in postmenopausal women, yet rarely in the non-gravid, premenopausal uterus. This report describes the case of uterine torsion secondary to a large pedunculated fibroid in a 34-year-old nulliparous woman.
Case Report: The patient presented with sudden onset of severe left sided abdominal pain which started during mild exertion. On examination she had a tender uterus which was enlarged secondary to a known large pedunculated fibroid. A planned myomectomy had been delayed due to the COVID-19 pandemic. Her pain worsened and therefore she was admitted with a working diagnosis of either torsion of the pedunculated fibroid or fibroid degeneration. A magnetic resonance imaging (MRI) scan was obtained which suggested torsion of the uterus itself and she was therefore taken for laparotomy for detorsion and myomectomy. The uterus, fallopian tubes, and ovaries were conserved and she recovered well postoperatively.
Conclusion: While uterine torsion in the non-gravid, premenopausal uterus remains extremely rare, it is an important diagnosis for clinicians to consider. This report discusses the diagnostic challenge when faced with a non-specific presentation. Magnetic resonance imaging can be helpful but ultimate diagnosis is surgical. Conservation of the uterus following torsion was possible in this case, giving the chance of fertility preservation. Finally, as demonstrated here, the impact of the COVID-19 pandemic on health services has caused delays to surgery which have had life and fertility-threatening consequences.
Keywords: Fertility preservation, Fibroids, Uterine conservation, Uterine torsion
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Acknowledgments
The authors would like to thank the patient for giving consent to share her story.
Author ContributionsMadeleine Trowsdale Stannard - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Maya Whittaker - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Natasha Abdul Aziz - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Brianna Cloke - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Yasser Diab - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Jonathan Gaughran - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Audrey Jacques - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Tom Holland - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Tejal Amin - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Madeleine Trowsdale Stannard et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
