Korean J Obstet Gynecol.  2011 Oct;54(10):647-650. 10.5468/KJOG.2011.54.10.647.

A case of torsion of a pedunculated subserosal uterine leiomyoma accompanied with acute gastroenteritis: A possible diagnostic pitfall

• Han JH
• Jung EY
• Jeon SY
• Park HY
• Jeong NH
• Lee BY

• KMID: 1836755
• DOI: http://doi.org/10.5468/KJOG.2011.54.10.647

Abstract

A literature search on acute abdomen caused by a leiomyoma does not yield many specific reports of myoma-related complications or the presenting features. We describe a case of torsion of a pedunculated subserosal uterine leiomyoma in a 25-year-old virgin female who noticed lower abdominal pain with severe diarrhea, which was assumed to be typical acute gastroenteritis undoubtedly. Awareness of the condition and a high index of suspicion are keys to early diagnosis and prompt intervention. A description of unique clinical features and radiologic evaluation is discussed.

Keyword

Leiomyoma; Uterus; Torsion; Abdominal pain; Gastroenteritis

MeSH Terms

Abdomen, Acute
Abdominal Pain
Adult
Diarrhea
Early Diagnosis
Female
Gastroenteritis
Humans
Leiomyoma
Uterus

Figure

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  Fig. 1 Contrast-enhanced computerized tomography scans show moderately enhanced uterine corpus connected to a non-enhanced pelvic mass with a small amount of ascites.

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  Fig. 2 Plain abdominal X-ray shows mild ileus bowel gas pattern after computerized tomography scan.

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  Fig. 3 Transrectal ultrasound shows a solid mass with heterogenous echogenicity behind the uterine corpus.

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  Fig. 4 Leiomyomatous tissues show multifocal hemorrhage and congestion with dilatated vessels, which is typical pathologic features of torsion (H&E, ×100).

Reference

1. King RE, Wightman JM. Mark JA, editor. Abdominal pain. Rosen's emergency medicine: concepts and clinical practice. 2006. 6th ed. Philadelphia (PA): Msby;209–220.

2. Chen EH, Shofer FS, Dean AJ, Hollander JE, Robey JL, Sease KL, et al. Derivation of a clinical prediction rule for evaluating patients with abdominal pain and diarrhea. Am J Emerg Med. 2008. 26:450–453.

3. Gaym A, Tilahun S. Torsion of pedunculated subserous myoma: a rare cause of acute abdomen. Ethiop Med J. 2007. 45:203–207.

4. Gupta S, Manyonda IT. Acute complications of fibroids. Best Pract Res Clin Obstet Gynaecol. 2009. 23:609–617.

5. Park SH, Park JS, Hong SY, Kim JH, Oh HK, Choi YS. A case of torsion of a subserosal leiomyoma. Korean J Obstet Gynecol. 2009. 52:970–973.

6. Roy C, Bierry G, El Ghali S, Buy X, Rossini A. Acute torsion of uterine leiomyoma: CT features. Abdom Imaging. 2005. 30:120–123.

7. Potter AW, Chandrasekhar CA. US and CT evaluation of acute pelvic pain of gynecologic origin in nonpregnant premenopausal patients. Radiographics. 2008. 28:1645–1659.

8. Marcotte-Bloch C, Novellas S, Buratti MS, Caramella T, Chevallier P, Bruneton JN. Torsion of a uterine leiomyoma: MRI features. Clin Imaging. 2007. 31:360–362.