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Obstetrics and gynaecology
Torsion of a large subserosal fibroid along with omental torsion adherent to it: a rare cause of acute abdomen
  1. Rishu Goel1,
  2. Richa Vatsa2,
  3. Aparna Sharma3 and
  4. Vidushi Kulshrestha3
  1. 1 Obstetrics and Gynecology, All India Institute of Medical Sciences, Muzaffarnagar, Uttar Pradesh, India
  2. 2 Obstetrics and Gynecology, All India Institute of Medical Sciences, Noida, Uttar Pradesh, India
  3. 3 Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India
  1. Correspondence to Dr Richa Vatsa; dr.richavatsa{at}gmail.com

Abstract

A woman in her 30s presented to emergency with complaints of acute lower abdominal pain for 3 days, not associated with any menstrual, bowel or urinary symptoms. Examination revealed an abdominopelvic mass corresponding to an 18-week gravid uterus with diffuse tenderness and guarding over her lower abdomen. The patient was a follow-up case of subserosal fibroid uterus, chronic kidney disease stage 4 and rheumatic heart disease on anticoagulants. Fibroid degeneration or torsion was suspected. Ultrasound revealed a large posterior wall subserosal fibroid with free fluid in the pelvis. As findings did not suggest degeneration or pedunculated fibroid, noncontrast CT was done, which showed a similar mass with a pedicle arising from the uterine fundus with free fluid with no other evident cause of acute abdomen. The patient was taken up for emergency laparotomy. Intraoperatively, it was found to be a case of subserosal fibroid with greater omentum adhered to it and twisted around its axis about eight times. This case is being reported to highlight a rare cause of acute abdomen.

  • Reproductive medicine
  • Surgery

https://doi.org/10.1136/bcr-2023-258651

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: RG, RV. The following authors gave final approval of the manuscript: AS, VK.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.