Postmenopausal Uterine Torsion with Hemorrhagic Shock Mimicking a Giant Ovarian Tumor: A Case Report

Postmenopausal uterine torsion is an extremely rare gynecological emergency that is often challenging to diagnose preoperatively because of its atypical presentation. This case is particularly noteworthy for a 10-year history of an untreated abdominal mass that rapidly evolved into a life-threatening condition, along with a striking discrepancy between the initial imaging suspicion and the final pathological diagnosis.

A 75-year-old Asian woman presented with chronic abdominal distension for 10 years and acutely worsening severe generalized abdominal pain for 1 day. Contrast-enhanced computed tomography (CT) revealed a huge pelvic mass initially misinterpreted as a giant ovarian tumor. The patient's condition deteriorated rapidly into hemorrhagic shock. Emergency exploratory laparotomy confirmed a 720° clockwise uterine torsion. Total hysterectomy with bilateral salpingo-oophorectomy was performed without detorsion. Postoperative histopathology confirmed multiple uterine leiomyomas (lipoleiomyoma with extensive hemorrhagic necrosis). The patient recovered uneventfully.

Although rare, postmenopausal uterine torsion should be considered in the differential diagnosis of acute abdomen in elderly women with known pelvic masses. Timely emergency surgery is life-saving, especially in those presenting with hemorrhagic shock. This case underscores the importance of regular clinical and ultrasound follow-up for postmenopausal women with known giant uterine masses, even when asymptomatic.