A rare case of uterine torsion with bilateral ovarian torsion: a diagnostic challenge

Uterine torsion is a rare and difficult condition that is most commonly encountered in pregnant women, but it can also affect non-pregnant patients. We report a case of ute­rine torsion accompanied by bilateral ovarian torsion, as­so­cia­ted with a large pedunculated subserosal fibroid, in a non-gravid patient who had previously undergone caesarean section following an in vitro fertilization (IVF) procedure. The patient complained of acute pelvic-ab­do­mi­nal pain, vomiting and lower back pain, which worsened over the course of one week. Diagnostic imaging, including contrast-en­hanced CT and ultrasound, revealed a giant cystic pelvic mass with vascularization, which initially suggested an ovarian origin. However, urgent laparotomy revealed a 25-cm fibroid with extensive necrosis and torsion. A total hysterectomy with bilateral adnexectomy was performed. The histopathological analysis confirmed a pedunculated subserosal uterine leiomyoma with ischemic necrosis and cystic transformation. Postoperatively, the patient recovered well, and she was discharged after four days. This case high­lights the importance of considering uterine torsion in the differential diagnosis of pelvic masses, particularly when associated with large fibroids.