A case of uterine torsion concurrent with a ruptured ovarian endometrial cyst

Abstract

The patient was a 54-year-old female presented with severe abdominal swelling and intermittent pain. On emergent CT, massive ascites with thickened peritoneum and intra-pelvic cystic mass approximately 20 cm in diameter were observed. The cyst wall showed redundant irregular shape. The uterus was enlarged with intramural mass located at its right anterior fundus. MRI showed this pelvic cyst as high intensity on T1-weighted images, so that it was suspected as an endometrial cyst. The operation revealed the rupture of endometrial cyst and the uterine torsion of 180° around the long axis. Retrospectively, the X-shaped configuration of the upper vagina was observed on MRI and both the adnexa, including right ovarian cyst, were connected to the opposite side ovarian vein. Torsion of a non-gravid uterus is rare. In this case, the uterine torsion seemed to be caused by enlarged uterine body and ruptured endometrial cyst. Radiologists should be aware of this potential complication of huge ovarian mass and enlarged uterus and its appearance.

Uterine torsion with necrosis of bilateral adnexa in a postmenopausal woman

“…Diagnosis of uterine torsion is difficult with ultrasound alone. Suspicion for uterine torsion is usually seen when comparing previous ultrasounds and observing changes in anatomic location of pelvic structures 4–6. Our patient, unfortunately, did not have a prior ultrasound for comparison, and CT imaging plus laparotomy were used for diagnosis.…”

The twisted uterus: A rare presentation of uterine torsion

“…Risk factors include structural anomalies that distort pelvic anatomy, such as pregnancy, uterine fibroids [4], ovarian cysts [5] and adnexal tumors, and ligamentous laxity in the pelvis [6,7]. Presentation is variable and often includes non-specific features, ranging from intermittent abdominal pain to acute deterioration with hemodynamic instability [8][9][10].…”

“…increasing the risk of uterine torsion include structural anomalies that distort pelvic anatomy, such as pregnancy, uterine fibroids [4], ovarian cysts [5], and adnexal tumors, and ligamentous laxity in the pelvis [6,7]. Multiple case reports have described torsion either in the gravid uterus [2,6] or in postmenopausal women [7][8][9], yet rarely in the non-gravid, premenopausal uterus. To the best of our knowledge, there remains only a single case of uterine torsion in a premenopausal non-gravid woman in the literature, described in 1935 [1].…”

“…There was exquisite tenderness over the fundus. Speculum examination was normal and her inflammatory markers were unremarkable (white cell count 9.6×10 9 /L [normal range 4.0-11.0×10 9 / L], and C-reactive protein 7 mg/L [normal range 0-4 mg/L]). Her pregnancy test was negative.…”

Welcome to the JSAR radiologic–pathologic correlation section

“…Welcome to the JSAR (Japanese Society of Abdominal Radiology) Radiologic-Pathologic Correlation Section. This new section includes 6 case reports [1][2][3][4][5][6] with beautiful pathological correlation. As the President of the JSAR, it is my great pleasure to introduce where and how these case reports come from.…”