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Torsion of a subserosal uterine leiomyoma

Case contributed by Mohamed Saber
Diagnosis almost certain

Presentation

Acute pelvic pain

Patient Data

Age: 35 years
Gender: Female

Midline ovoid well-defined mass lesion is seen inseparable from the uterine fundus and closely related to anterior abdominal wall with bowel loops seen splayed around. It measures about 5 x 10 x 6 cm along its largest AP, TR and CC dimensions respectively. It elicits intermediate to high signal intensity on T1 and peripheral low signal intensity, central high signal on T2. The mass shows no enhancement on post-contrast study.

Case Discussion

Uterine leiomyoma is a benign subclinical gynecological tumor occurring frequently in women of childbearing age. The symptoms include menorrhagia, abnormal vaginal bleeding, dysmenorrhea, dyspareunia, pelvic pain, and urination frequency. The infrequent acute complications include thromboembolism, acute torsion, renal failure and acute pain due to secondary degeneration.

In this case, the uterus was normal, but the subserosal leiomyoma was twisted to cause acute abdominal pain. The torsion of subserosal leiomyoma should be treated by a surgical approach immediately upon suspicion.

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