Torsion of Non-gravid Uterus: A Life-Threatening Condition in a Postmenopausal Lady
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CASE REPORT
Torsion of Non‑gravid Uterus: A Life‑Threatening Condition in a Postmenopausal Lady Vaishali B. Nagose1,2 · Reny Sadanandan Rosemary2,3 · Rakesh C. Anandrajan4,5 · Nita Hubert5 · Reethu Raj6 Received: 5 December 2019 / Accepted: 7 June 2020 © Federation of Obstetric & Gynecological Societies of India 2020
Introduction
Case Presentation
Uterine torsion, defined as uterine rotation on its long axis by more than 45 degrees, is a rare condition. When seen in a non-gravid uterus, it is quite extremely rare condition (less than 50 cases reported). Also, only few such cases in postmenopausal age group have been reported till now [1]. Clinically presenting as acute abdomen, it is potentially fatal. But, the coexistent clinical findings are non-specific, making it difficult to be diagnosed preoperatively. Torsion of the vessels at the pedicle causing irreversible ischaemic damage of the uterus may lead to rapid clinical deterioration. Thus, whenever it is suspected as being the possible diagnosis, immediate care is essential.
A 57-year-old postmenopausal woman came with complaints of acute abdominal pain and vaginal spotting, increasing the intensity, since three days. On examination, an abdominal mass could be palpated per abdomen arising from pelvis. Tenderness all over the abdomen with guarding was present. On per vaginal examination, the upper part of vagina was obliterated. Vaginal speculum could not be inserted; thus, cervix was not visualized. On bimanual examination, the abdominal mass was found to be tender uterine mass. Blood tests were normal except for raised white blood cell (WBC) count. Ultrasound examination suggested a huge mass arising from uterus, possibly a fibroid with areas of degeneration. The CT scan confirmed a large fibroid with calcifications arising from the uterine body and stretched round ligament lying beneath the peritoneum and twisted dense uterine vessels in the pedicle (Fig. 1), suggestive of torsion of uterus. As the clinical condition of the patient was rapidly deteriorating and her blood pressure started dropping, an emergency hysterectomy was performed. Intraoperatively, a huge fibroid arising from the uterus was found filling the abdominal and pelvic cavity, and swollen adnexa almost lying anteriorly to the uterus with stretched round ligaments. The uterus and adnexa, found to be 270° torted at cervix, were swollen, purplish-black, soft and soggy (Fig. 2a). The uterine corpus was derotated and supracervical hysterectomy with bilateral salpingo-oophorectomy was performed. Blood transfusion,
Dr. Vaishali B Nagose, MD Pathology. Associate Professor, Department of Pathology, Dr Ulhas Patil Medical College, Jalgaon (Khurd), Maharashtra, 425309, India; Ex Associate Professor, Department of Pathology, Dr SM CSI Medical College, Karakonam 695504, Thiruvananthapuram, Kerala, India; Dr. Reny Sadanandan Rosemary, MD Pathology. Assistant Surgeon, Rural Health Centre, Kannur 670353, Kerala; Ex Resident (Post Graduate Student), Department of Pathology, Dr SM CSI Medical College,
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