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.
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Clinical presentation
acute abdominal pain
GIT symptoms (e.g diarrhea)
tenderness in the lower abdomen 1
Pathology
gross picture: the torsed mass appears dark blue on a twisted pedicle
microscopic picture: hemorrhagic leiomyoma shows multifocal hemorrhage, congestion and vascular ectasia 1.
Radiographic features
Ultrasound:
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
MRI:
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.
Complications
If left untreated; gangrene, bleeding or peritonitis may occur 2,3.
Differential diagnosis
uterine leiomyoma with secondary degeneration
ovarian torsion: twisted pedicle of an enlarged ovary and non-identification of one of the ovaries
GIT conditions: appendicitis and gastroenteritis
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