A Rare Case of Uterine Torsion in a Nongravid Uterus: A Case Report and Literature Review

Background: Uterine torsion in a nongravid uterus is an extremely rare gynecologic emergency. Diagnosis is crucial as any delay could potentially lead to severe implications on future fertility or even life-threatening consequences. However, diagnosis remains extremely difficult and this condition is rarely diagnosed clinically. Case: A 37-year-old single lady, virgo intacta, presented with left iliac fossa pain for 2 days duration. Physical examination revealed a soft nontender abdomen with a firm left-sided abdominopelvic mass. Computed tomography (CT) scan showed a severely enlarged uterus measuring 26.0 × 14.1 × 26.1 cm, with suggestion of swirling of the adnexal vessels and uterine cervix. A presumed diagnosis of uterine torsion was made and she was counseled for surgical intervention. Results: This patient underwent a midline laparotomy, with the uterus, along with a large 22 cm fibroid, found to be rotated four times along its longitudinal axis. Detorsion of the uterus followed by myomectomy was performed and the large fundal fibroid was sent for frozen section, which revealed a infarcted but benign leiomyoma with no malignancy. The patient made an uneventful postoperative recovery. Conclusion: In view of the potential for significant morbidity and mortality as well as severe implications on fertility, uterine torsion should be considered among the differential diagnoses in a female patient with acute abdominal pain. The aid of imaging such as CT or magnetic resonance imaging scans has a significant role to play and should be interpreted with a high index of suspicion. Timely intervention, mainly through urgent surgical intervention, is crucial.