Torsion of subserosal leiomyoma of the uterus refers to the twisting of the attached pedicle of a pedunculated subserous leiomyoma of the uterus with subsequent ischemia, necrosis and gangrene 1.
acute abdominal pain
GIT symptoms (e.g diarrhea)
tenderness in the lower abdomen 1
gross picture: the torsed mass appears dark blue on a twisted pedicle
microscopic picture: hemorrhagic leiomyoma shows multifocal hemorrhage, congestion and vascular ectasia 1.
normal uterus with heterogeneous echogenicity of pedunculated para- uterine mass
mild pelvic free fluid
color Doppler demonstrates twisted pedicle with no blood flow within the mass
T1: intermediate to high signal intensity related to hemorrhagic necrosis
T2: peripheral low signal and central high signal intensity
T1 with contrast: no enhancement
The uterus is of normal signal and enhancement 1.
Treatment and prognosis
Once suspected, immediate surgical interference is mandatory to avoid complications.
If left untreated; gangrene, bleeding or peritonitis may occur 2,3.
- 1. Kim HG, Song YJ, Na YJ, Choi OH. A case of torsion of a subserosal leiomyoma. (2013) Journal of menopausal medicine. 19 (3): 147-50. doi:10.6118/jmm.2013.19.3.147 - Pubmed
- 2. C. Roy, G. Bierry, S. El Ghali, X. Buy, A. Rossini. Acute torsion of uterine leiomyoma: CT features. (2004) Abdominal Imaging. 30 (1): 120. doi:10.1007/s00261-004-0240-1 - Pubmed
- 3. Marcotte-Bloch C, Novellas S, Buratti MS, Caramella T, Chevallier P, Bruneton JN. Torsion of a uterine leiomyoma: MRI features. (2007) Clinical imaging. 31 (5): 360-2. doi:10.1016/j.clinimag.2007.05.002 - Pubmed