Non-gravid uterine torsion associated with small bowel obstruction

TL;DR

A post-menopausal woman with a large calcified uterus experienced uterine torsion and bowel obstruction, requiring surgery for full recovery.

Contribution

This case highlights non-gravid uterine torsion in an elderly patient with a large leiomyomatous uterus.

Findings

Computed tomography revealed a small bowel obstruction caused by a large calcified pelvic mass.

Surgery showed uterine torsion with perforation and adhesion of a healthy jejunum segment to the uterine fundus.

Histopathology confirmed calcified leiomyoma with hemorrhagic infarction of the uterine wall.

Abstract

Uterine torsion is a rare condition. Even more so in cases of non-gravid torsion. We present the case of a post-menopausal woman in her 70s who arrived to our emergency department acutely unwell with abdominal pain and vomiting on a background of a large leiomyomatous uterus, complicated by aspiration pneumonia, acute anaemia, and acute kidney injury. Computed tomography demonstrated a small bowel obstruction secondary to a large heterogeneous calcified pelvic mass. Laparotomy performed demonstrated a large leimyomatous uterus that had torted on the cervical pedicle associated with perforation of the lower anterior segment. A short segment of healthy jejunum was adhered to the uterine fundus, which was easily mobilized. Total hysterectomy and bilateral oophorectomy was performed. The patient made a full recovery. Histopathology demonstrated a calcified leiomyomatous uterus with adjacent haemorrhagic infarction of the uterine wall.

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