The rarity of nongravid uterus torsion – difficult diagnosis even in modern medicine

Uterine torsion is a rare surgical emergency that can evolve with ischemic lesions of the genital organs. We present a case of a 59 year-old woman who was hospitalized with important abdominal pain and modified general status. On clinical examination, a giant abdominal mass was found, and bimanual genital palpation could not find the cervix but revealed tension in the vaginal walls. CT examination described the palpable tumor mass as a giant uterine leiomyoma, with no information regarding the adnexes. As her general status become critical within 24 hours, the surgical intervention was performed, although the patient refused it. The abdominal exploration discovered a giant engorged uterus with 720-degree dextro-isthmic rotation around its axis; both fallopian tubes, broad ligaments, round ligaments and ovaries were also rotated and ischemic. She underwent subtotal hysterectomy with favorable postoperative outcome. The pathological report showed that the uterus and the annexes had ischemic to necrotic lesions. This case shows that the diagnosis of uterine torsion can be a pitfall due to its rarity. The disease has fatal evolution if the correct treatment is not applied on time.