A Case of Torsion of Gravid Uterus Caused by Leiomyoma

Gururaj, Deshpande; Kaul, Rajesh; Manjuladevi, P

doi:10.1155/2011/206418

Cited by 20 publications

(23 citation statements)

References 8 publications

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“…As in our case, the acute presentation of pain and maternal collapse in many case reports in the literature leads the attending clinicians to misdiagnose the woman with one of the other obstetric emergencies (scar dehiscence, uterine rupture, placental abruption), the true diagnosis only being realised during caesarean section 12. In our case, there were subtle signs, which if fully appreciated, may have elicited uterine torsion as a differential diagnosis preoperatively:

Persistent vomiting, although a non-specific symptom often brought on by pain, was probably caused by vagal stimulation.

Admission blood pressure was low, indicating neurogenic shock rather than hypovolaemia.

…”

Section: Discussionmentioning

confidence: 66%

“…Ultrasound, CT and MRI have been described in confirming the diagnosis of uterine torsion 12. However, as uterine torsion presents either with vague symptoms or as in our case with an obstetric emergency necessitating urgent delivery, it is unlikely that imaging will commonly be used for diagnostic purposes.…”

Section: Discussionmentioning

confidence: 76%

“…Urinary and gastrointestinal symptoms may be as a result of direct compression or displacement of affected organs. Shock in these women can be hypovolaemic shock following haemorrhage, or neurogenic shock caused by profound parasympathetic nerve stimulation, similar to that of cervical shock 6 12…”

Section: Discussionmentioning

confidence: 99%

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A rare obstetric emergency: acute uterine torsion in a 32-week pregnancy

2014

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Uterine torsion is rare in pregnancy and the cause in most cases is unknown. It is associated with fetal compromise, with perinatal mortality reported to be around 12%. Our case describes an acute torsion, presenting in pregnancy with severe abdominal pain and vomiting with a viable 32-week gestation. Emergency caesarean section was performed and the 180° uterine torsion was diagnosed intraoperatively. Posterior hysterotomy was required for delivery prior to detorsion of the uterus. This report describes that prompt recognition and intraoperative vigilance can achieve a successful maternal and fetal outcome in this rare and difficult obstetric scenario.

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Persistent vomiting, although a non-specific symptom often brought on by pain, was probably caused by vagal stimulation.

Admission blood pressure was low, indicating neurogenic shock rather than hypovolaemia.

…”

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 76%

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A rare obstetric emergency: acute uterine torsion in a 32-week pregnancy

2014

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“…When it progresses to uterine artery obstruction, placental perfusion reduces and can lead to fetal demise; a similar pathophysiology might have been present in our case. Uterine leiomyoma complicates 1.4% of pregnancies 7. Diagnosis can be made by ultrasound or MRI.…”

Section: Discussionmentioning

confidence: 99%

Complete axial torsion of pregnant uterus with leiomyoma

et al. 2014

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Uterine torsion is defined as a rotation of the uterus of more than 45° along its long axis. It is a rare complication during pregnancy; a common cause of torsion can be uterine myoma. Here we describe the case of a 27-year-old G2P1+0 woman at 15 weeks 3 day pregnancy, who presented to our outpatient department as a case of acute abdomen, in a state of shock. Clinical findings did not correlate with investigation. On lapratomy she was diagnosed as a case of complete axial torsion of pregnant uterus with fundal myoma with massive abruption. Early diagnosis and timely intervention would help in improving both maternal and fetal outcome.

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“…There are reports of myomectomy and posterior vertical incisions in some cases. 9,10 To prevent recurrence of the torsion plication of round ligaments or uterosacrals are reported in the literature. 11,12 In our case no recurrence of the torsion was seen in the follow-up period.…”

Section: Figure 2: Posterior View Of the Uterus After Detorsionmentioning

confidence: 99%