Torsion of subserosal leiomyoma of the uterus

Last revised by Mostafa Elfeky on 4 Mar 2020

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. 

Once suspected, immediate surgical interference is mandatory to avoid complications.

 If left untreated; gangrene, bleeding or peritonitis may occur 2,3.

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