Complete Uterine Torsion Secondary to a Massive Uterine Fibroid: A Case Report

Uterine torsion is an uncommon but life-threatening condition defined by the abnormal rotation of the uterus around its longitudinal axis, with the majority of cases occurring during the third trimester of pregnancy. While rare in nonpregnant patients, factors such as uterine fibroids, Müllerian anomalies, and pelvic adhesions can predispose individuals to this condition, leading to severe complications if not readily diagnosed and treated. We report the case of a 37-year-old nulliparous woman who presented with acute right-sided abdominal pain radiating to the back. CT and MRI evaluation revealed a massive subserosal uterine fibroid measuring 21.7 x 12.9 x 17.3 cm, causing complete uterine torsion with the left adnexa displaced to the right pelvis. Surgical intervention confirmed a 360-degree torsion, and the patient underwent successful detorsion and resection of the fibroid, which weighed 2.168 kg. Histopathological examination confirmed a benign leiomyoma with no evidence of malignancy. This case highlights the importance of early diagnosis and timely surgical intervention in managing uterine torsion secondary to fibroids. Diagnosing uterine torsion is challenging due to its nonspecific clinical presentation and overlap with other acute gynaecological emergencies. Imaging modalities such as ultrasound, CT, and MRI are valuable for preoperative diagnosis, but surgical exploration remains the gold standard for definitive diagnosis and management.