Torsion of full term pregnant uterus with huge ovarian cyst — a case report

Abstract

A 20-year-old primigravida married since 1 year, was admitted with 36 weeks pregnancy along with a mass and acute pain in the abdomen. In early pregnancy she visited local doctors for the confirmation of pregnancy. Thereafter she had no antenatal checkup. At 35 weeks of pregnancy she noticed an excessive enlargement of the abdomen but she did not visit any doctor. On the day of admission she had a sudden severe pain in the abdomen which was associated with vomiting and fainting. She went to a local doctor who after initial resuscitation referred her to this hospital. Her complaints were continuous pain all over the abdomen, aggravated by movements and associated with vomiting. She was afebrile, pale, and normotensive with tachycardia. Symphysio fundal height was 42cm. Abdomen was tender, fetal heart sounds were present and regular, ultrasound examination revealed 37 weeks fetus with active heart beat, 2.5 kilogram in weight. There was a huge cystic mass with internal echoes and thin septations, measuring 19x15cm in size lying above the uterus in the epigastric region Her hemoglobin was 9.0 gm%. She underwent emergency laparotomy. On exploration, she had dual pathology i.e. huge ovarian cyst without any torsion while the full term pregnant uterus was found twisted at lower uterine segment (Fig. 1). The uterus was untwisted; a live baby boy was delivered by lower segment caesarean section. The baby was hypoxic at the time of birth, resuscitated by the pediatrician. The ovarian cyst was having benign features, 20x18cm in size, and 7.5 kg in weight (Fig. 2). The other tube and ovary were normal. Right salpingo-oophorectomy was done. Her postoperative period remained uneventful. She was discharged on the 8th postoperative day. Histopathology report of the removed tumor was serous cystadenoma. DiscussionUterine torsion is the twist of the uterus at the junction between the cervix and the corpus more than 45 degrees around its long axis and mostly the degree of twist is 180 0 . Rarely does torsion of pregnant uterus occurs to such an extent that the uterine circulation is arrested leading to acute maternal symptoms and also threatenfetal survival. Thus it is usually associated with abruptio placentae. The risk factors for uterine torsion are abnormal fetal presentation i.e. transverse lie, uterine distention due to the leiomyoma, mullerian anomalies, pelvic adhesions and large neoplasms distorting the uterine shape or position. In this case the associated factor was large ovarian cyst. The incidence of the ovarian tumor in pregnant women is 1/1000 1 deliveries.Torsion of the full term pregnant uterus is a rare obstet-