Uterine torsion in the second trimester of pregnancy

Torsion of the pregnant uterus is a very rare complication. It may occur at any gestational age. The treatment depends on the intensity of symptoms, intraoperative ischemic signs and the gestational age.

We present a case report of 33-year-old primipara accidentally diagnosed with uterine torsion during appedectomy.

The patient underwent surgery at 19th week of gestation due to severe pain in the right iliac fossa and increased levels of inflammation markers. Intraoperatively acute appendicitis and levorotation of the uterus by about 100 degrees were found. As the signs of ischemia were absent, the uterus was returned into its normal position. Intraoperative and postoperative period was uncomplicated. Close outpatient monitoring was introduced and the pregnancy continued without further complications. The patient underwent cesarean section at 36 weeks of pregnancy due to early leakage of amniotic fluid and failure to progress during first stage of labor.

Uterine torsion may present with non-specific symptoms or be asymptomatic. Urgent laparotomy and rotation of the uterus into its normal anatomical position gives chance for normal course of pregnancy. Subsequent close outpatient care is obligatory to asses viability of the fetus and early detection of possible pregnancy complications.