A case of uterine torsion with a huge calciferous uterine leiomyoma in a postmenopausal (non-gravid) woman

Abstract

Torsion of a non-gravid uterus is extremely rare. This report concerns an 83-year-old woman. She was admitted to our hospital with abdominal pain and appetite loss. She had a firm, smooth, and mobile mass with an approximately 15 cm calciferous region by X-ray in the lower abdomen, rising out of the pelvis above the umbilicus. The abdomen was soft with no muscle guarding or rebound tenderness. MR image (T2-weighted sagittal image) demonstrated a cervix but not a uterine corpus (appeared as post-supracervical hysterectomy). We diagnosed malignant ovarian tumor at that time because of the enhancement on contrast enhanced images and the elevation of tumor markers. After hospitalization, her white blood cell count was elevated with high fever. In spite of antibiotic therapy, she progressively worsened. After the eleventh day, a new space-occupying region was detected on CT scan, and the preoperative differential diagnosis was also abcess in the pelvis. A laparotomy was performed. We found a huge calciferous uterine subserosal-leiomyoma. The uterus had undergone 540 rotation towards the left around the long axis of the uterus between the corpus and cervix uteri. There were no obvious ovarian tumors present. A supracervical hysterectomy with bilateral salpingo-oohorectomy was completed because of the weakness of the parametrium tissue and the uterine cervix. The patient's postoperative course was unremarkable and she was discharged in good conditon. Recognition that the parametrium had assumed a radial configuration on MRI may lead to the correct preoperative diagnosis.[Adv Obstet Gynecol, 59(1) : 6-9, 2007 (H19.2)]