Case of suspected torsion and amputation of myoma during pregnancy

Uterine myoma occurs in 1.6-2% of pregnancies. Most myomas during pregnancy are asymptomatic, but 10-20% may develop complications. The most common complication is abdominal pain, usually caused myoma degeneration or torsion of a pedunculated myoma.

A 40-year-old pregnant woman was transferred with severe left upper abdominal pain with suspicion of left ovarian torsion at 32 weeks of gestation. Magnetic resonance imaging (MRI) demonstrated a 9.8 cm-sized oval mass abutting the uterine fundus, suggesting subserosal myoma with degeneration. She was admitted for pain control, and the pain was relieved in a few days with conservative management. Two years later, she revisited our hospital for the treatment. Total laparoscopic hysterectomy with bilateral salpingectomy was performed. A 6-cm isolated solid mass adhering to the omentum in the pelvic cavity was observed intraoperatively. The trace on the anterior wall of the uterus was considered to be a broken pedicle that had initially connected the mass.

In our case, the patient had severe abdominal pain, and ultrasound and MRI findings suggested subserosal myoma degeneration. A retrospective diagnosis of torsion was made following the surgery, which was assumed to cause the pain during pregnancy, and that an amputation occurred during or after the pregnancy.

Diagnosis is based on clinical manifestations and radiologic examination, however, it is usually difficult to diagnose preoperatively, especially among pregnant women who have diagnostic test limitations. Therefore, if a pregnant woman with a myoma complains of abdominal pain, various possibilities should be considered.