Torsion of a Giant Leiomyomatous Uterus in a Postmenopausal Woman

Abstract

Abstract

Background: Although uterine leiomyomas are the most common tumors of the female reproductive tract, giant myomas are exceedingly rare, and present a great diagnostic and therapeutic challenge. The prevalence of uterine torsion is not known, but it is at best, rare. Case: This article illustrates a case of a 55-year-old cachectic woman who presented with long-standing abdominal distension. Physical examination revealed a huge abdominopelvic mass suspicious for ovarian malignancy. Computed tomography scanning was suggestive of a degenerated calcified giant leiomyoma. Laparotomy disclosed a uniformly enlarged uterus measuring 30×27×21 cm, with torsion of the entire uterus. Total hysterectomy with bilateral salpingo-oophorectomy was performed, and histopathology confirmed the diagnosis of a giant leiomyoma with degeneration. Results: The patient was discharged on the 7th postoperative day, and followed up regularly. She continues to be in good health 2 years after the surgery. Conclusions: Uterine torsion can be asymptomatic; however, potentially serious sequelae are possible. Patients with giant myomas present an unusual challenge, even for the most experienced gynaecologists; therefore, multidisciplinary patient care may help reduce morbidity. (J GYNECOL SURG 30:118)