Torsion of a uterine leiomyoma: MRI features

Uterine leiomyoma torsion: A rare cause of acute abdominal pain

INTRODUCTION

Leiomyoma torsion is an incredibly rare entity. Diagnosis is frequently intraoperative due to poor correlation between clinical symptoms and radiological findings. We report a case of a twisted uterine leimyoma diagnosed intraoperatively.

CASE PRESENTATION

Our patient was 46 years old, nulliparous woman, presented to the emergency department with three days of acute pelvic pain. On physical examination, a firm and tender pelvic mass was palpable, extending below the umbilicus, suggestive of uterine origin. Laboratory investigations revealed an inflammatory response. Ultrasound identified a large abdomino-pelvic mass adherent to the right side of the uterus, with no detectable blood flow on Doppler examination. Given the diagnostic uncertainty, exploratory laparoscopy was performed. The diagnosis of a pedunculated Leiomyoma torsion with acute appendicitis was confirmed. Initially we performed a fibroid detorsion then a myomectomy and appendectomy were performed.

CLINICAL DISCUSSION

The torsion of the vascular pedicle of a subserous leiomyoma can lead to ischemic gangrene and peritonitis, which can cause mortality. The risk factors that contribute to the fibroid torsion include the size, the stalk of the pedunculated myoma that must be thin and long in order for it to undergo rotation and torsion. There are no specific clinical signs or imaging modalities that reliably indicate the diagnosis. A diagnostic laparoscopy is most often indicated in case of diagnostic doubt. Surgery may consist in myomectomy or hysterectomy.

CONCLUSION

It is important to consider the possibility of torsed leiomyoma in the differential diagnosis in any woman presenting with an intra-abdominal and pelvic mass with acute abdomen.

Imaging findings of fibroid torsion in pregnancy: A case report

When our patient presented emergently to labor and delivery at 18 weeks pregnant with severe right abdominal pain, the common diagnoses (such as appendicitis, cholecystitis, etc.) were on the top of the differential. However, US and MRI revealed a rarer cause of her pain, a pedunculated fibroid. The most important question then became whether this fibroid had torsed, which would require surgical intervention to prevent life-threatening sequelae. Unfortunately, presurgical imaging diagnosis of fibroid torsion in pregnancy is difficult. We offer a description of our patient's imaging findings, which align with other radiologic descriptions of fibroid torsion in pregnancy in the literature, to contribute to the radiologist's diagnostic confidence in this patient population.

Pedunculated subserosal leiomyoma with torsion, a rare cause of abdominal pain: A case report

INTRODUCTION

Acute abdominal pain caused by torsion of the pedunculated subserosal leiomyoma is rare. Miss diagnosis can lead to ischemia, necrosis, and subsequent peritonitis which may cause significant morbidity. Torsion of the leiomyoma should be recognized as a surgical emergency and once suspected, early surgical intervention should be considered.

PATIENT CONCERNS

A 28-year-old woman with a medical history of uterine leiomyoma presented to our emergency department because of acute onset right lower abdominal pain.

DIAGNOSES

The computed tomography was performed which demonstrated multiple leiomyomas of variable sizes and a subserosal leiomyoma located at right lower abdomen with poor contrast enhancement.

INTERVENTIONS

The gynecologist was consulted, and myomectomy was performed. The intraoperative finding showed a pedunculated subserosal leiomyoma with torsion.

OUTCOMES

She underwent myomectomy for the twisted pedunculated subserosal leiomyoma as well as other leiomyomas and was discharged with a favorable outcome.

CONCLUSIONS

Torsion of the leiomyoma is a surgical emergency as delayed in treatment may lead to marked morbidity. Once suspected, the gynecologist must be consulted, and surgical intervention should be considered.

Successful management of preoperatively diagnosed torsion of a subserosal uterine fibroid by pneumoperitoneum laparoscopic single-port surgery

OBJECTIVE

Preoperative diagnosis and successful management of acute torsion of a subserosal fibroid by using appropriate imaging modalities and single-port laparoscopic surgery.

CASE REPORT

A 44-year-old nulliparous woman presented with lower abdominal pain. Computed tomography and magnetic resonance imaging with contrast enhancement revealed a tumor in the pouch of Douglas with a low contrast at the center and thin-rim enhancement. Torsion of a uterine subserosal fibroid was diagnosed preoperatively. Laparoscopic single-port surgery by pneumoperitoneum was performed. Torsion of the pedicle attached to the uterine wall was excised by bipolar coagulation and cut with scissors. The extirpated fibroid was extracted from the umbilical wound. The pneumoperitoneum single-port laparoscopic surgery was completed as a gynecologic emergency operation.

CONCLUSION

Torsional uterine fibroids are difficult to diagnose preoperatively as symptoms are nonspecific and need emergent surgical management as an acute abdomen. Preoperative diagnosis using appropriate imaging modalities is important to perform single-port laparoscopic surgery.

Diagnostic ambiguity of aseptic necrobiosis of a uterine fibroid in a term pregnancy: a case report

Background

Uterine fibroids are the most common uterine tumours in females of reproductive age. During pregnancy, uterine fibroids may be complicated by aseptic necrobiosis. We herein report an ambiguous clinical presentation of uterine fibroids in pregnancy and discuss the diagnostic challenges encountered in our resource-constraint setting.

Case presentation

A term pregnant Cameroonian woman was admitted to our maternity unit with clinical findings suggestive of a strangulated umbilical hernia. She underwent an emergency caesarean section which fortuitously revealed aseptic necrobiosis of a uterine fibroid, managed within the same surgical intervention by myomectomy. Her post-operative course was uneventful.

Conclusion

The authors highlight the need for a high index of suspicion by healthcare providers, as well as the need for a multidisciplinary approach for a favourable maternal and foetal outcome.

Small bowel volvulus due to torsion of pedunculated uterine leiomyoma: CT findings

Torsion of a uterine leiomyoma is a rare complication that can be life threatening because of ischemia or necrosis. This condition may also lead to gastrointestinal complications such as obstruction or, more rarely, small bowel volvulus. Its diagnosis is difficult and can be facilitated with the use of computed tomography or magnetic resonance imaging. Treatment is based on emergency surgical resection of the twisted uterine leiomyoma and detorsion of the small bowel volvulus.

Torsion of a Subserosal Myoma Managed by Gasless Laparoendoscopic Single-Site Myomectomy with In-Bag Manual Extraction

Acute torsion of a subserosal myoma is a rare surgical emergency that is infrequently diagnosed preoperatively. Furthermore, laparoendoscopic single-site (LESS) myomectomy with in-bag tissue extraction for the management of this disorder has not yet been described. A 43-year-old, gravida 1, para 1 woman was referred to our department due to a solid pelvic mass associated with persistent abdominal pain. A pedunculated subserosal myoma with torsion was strongly suspected based on ultrasonography and magnetic resonance imaging. Emergency LESS surgery showed that the subserosal myoma arising from the posterior uterine wall torted at its pedicle in the cul-de-sac. The twisted myoma node was excised by coagulation and cut using a LigaSure Atlas, followed by in-bag manual morcellation and extraction through an umbilical wound. The present case report emphasizes that LESS myomectomy with in-bag tissue extraction is a feasible minimally invasive surgical option for the management of subserosal myoma with torsion after a precise imaging-based diagnostic evaluation.

Laparoscopic approach to fibroid torsion presenting as an acute abdomen in pregnancy

This case report demonstrates the safe application of laparoscopic excisional myomectomy in the first trimester of pregnancy.

Uterine leiomyomas (fibroids) are seen in up to 4% of pregnancies, and most commonly present with pain in pregnancy, which can be due to red degeneration or torsion. Most cases previously have been managed with open resection. We report the case of a 35-y-old primagravida woman, presenting with acute lower abdominal pain at 11 wk gestation. Ultrasound demonstrated an 8-cm fibroid only. She demonstrated features of lower abdominal peritonitis and was scheduled for a diagnostic laparoscopy. At operation, a torsed subserosal fibroid was found. She successfully underwent laparoscopic myomectomy with the endoGIA vascular stapler and subsequent Pfannenstiel delivery. The patient was discharged 48 h postoperatively to continue her pregnancy. This case demonstrates the safe application of laparoscopic excisional myomectomy in the first trimester of pregnancy. Previously reported cases in the literature have focused on open resection or bipolar diathermy enucleation and morcellation. A high degree of suspicion should be maintained for the diagnosis in patients presenting to the surgical service with acute lower abdominal peritoneal signs during pregnancy.

A case of torsion of a subserosal leiomyoma

Uterine leiomyoma is one of the most common gynecological tumor, whereas acute torsion of the uterine leiomyoma is very rare. We report a case of subserosal leiomyoma that was first detected by ultrasonography, and further confirmed as torsion of subserosal leiomyoma by laparoscopic surgery.

Pelvic tumors with normal-appearing shapes of ovaries and uterus presenting as an emergency (Review)

Abdominal pain with an associated pelvic mass is a common problem in everyday practice. Concerns about ectopic pregnancy, torsion of an enlarged ovary or malignancy usually dominate the diagnostic evaluation. On physical and imaging examination, when a palpable painful mass is present in the pelvis and the two ovaries and uterus are detected in their normal anatomical locations, the content and origin of the lesions may be significant in narrowing the pre-operative differential diagnosis. Thus, the emergent pelvic indications discussed in this review should be considered. The causes of acute abdominal pain are few in number and therefore an accurate diagnosis may be most frequently made at the time of exploratory laparotomy.

Torsion of a Uterine Leiomyoma: A Case Report and Review of the Literature

A 55 year-old woman presented with abdominal pain. Transvaginal ultasonography demonstrated an enlarged fibroid uterus. She underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy and was found to have torsion of a large pedunculated leiomyoma. There are fewer than 10 cases reported in the literature of torsion of a uterine leiomyoma.

The effect of myoma uteri and myomectomy on sexual function

INTRODUCTION

This is a report about the effects of myoma uteri and myomectomy on sexual function in women.

AIM

The aim of this article was to determine the effects of myoma uteri and myomectomy on sexual function in women.

METHOD

The study was designed as a controlled clinical study in an academic clinical research center. The study patients consisted of 80 women with myoma uteri and 75 control women. Baseline characteristics and properties of the myomas were recorded. A validated questionnaire was used to determine pre- and postoperative sexual function in the patients.

MAIN OUTCOME MEASURE

Female sexual function index (FSFI) scores of the women were recorded before and after surgery.

RESULTS

Women with myoma uteri had lower FSFI pain and satisfaction scores than women without it, even after correction for possible confounders. Fundal and posterior myomas were associated with pain, whereas only posterior myomas were related to the overall FSFI scores. However, although there was no relation between the volume of the myomas and the FSFI scores, women with a uterine volume over 200 cm(3) had significantly lower mean FSFI satisfaction, pain, and total scores. The mean FSFI pain and total scores of the patients improved significantly after undergoing a myomectomy.

CONCLUSIONS

The findings of this study suggest that a potential impairment of sexual function exists in women with myomas. This is mainly because of pain during sexual intercourse, although it does not seem to have an effect on either the arousal or orgasmic phases. Furthermore, the performance of a myomectomy may alleviate pain during intercourse, and thereby improve sexual function in the patients.