Case report: preoperative radiological diagnosis of uterine torsion in the non-gravid uterus

This case report describes the rare occurrence of a pre-operative radiological diagnosis of uterine torsion in the non-gravid uterus. A 78-year-old female presented with a 5-day history of worsening non-specific gastrointestinal symptoms. Her admission CT study initially reported a large adnexal mass lesion causing obstruction of neighbouring small bowel loops. Management was initiated under the presumption of a complex uterine fibroid causing local small bowel obstruction. Only a secondary radiological review-conducted due to persistent abdominal pain-identified the characteristic "whirlpool" sign of the uterine cavity and prompted the differential of uterine torsion. Contrast-enhanced MRI study further confirmed this suggestion with a lack of uterine contrast uptake and the "X-sign." The patient subsequently had an emergency laparotomy for a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Intra-operative findings and further histological analysis demonstrated a distorted uterine cavity with haemorrhagic infarction, confirming a diagnosis of uterine torsion.