Concomitant Uterine and Bilateral Adnexal Torsion in a Postmenopausal Woman: A Case Report

Adnexal torsion is a well-recognized gynecologic emergency; however, uterine torsion is less well-known. The majority of uterine torsions occur in gravid uteri; torsion in postmenopausal patients is rare. We report a case of uterine and bilateral adnexal torsion in a postmenopausal woman due to a large leiomyoma. This patient presented to the emergency department with acute onset pelvic pain in the setting of a known pelvic mass. Imaging findings were significant for a large pelvic mass that differed in location when compared to prior imaging. In addition, the cervix had a "twisted" appearance on imaging. Overall these findings were suspicious for uterine torsion, and surgical management was planned. Operative findings were significant for 720-degree uterine torsion at the level of the lower uterine segment due to a large subserosal fibroid extending into the left broad ligament. Pathology was significant for confirmed leiomyoma measuring 25 cm, with edema and myxoid changes, uterus and bilateral ovaries with hemorrhage and congestion, all of which supported the diagnosis of uterine torsion, which also resulted in bilateral adnexal torsion. This case demonstrates an instance of uterine and bilateral adnexal torsion that was managed in a timely fashion. If surgical treatment is delayed, grave sequelae can occur. Consideration of concomitant uterine and adnexal torsion during an acute pelvic pain workup is crucial to ensure appropriate inpatient management, preoperative counseling, surgical consent, and patient safety.