Acute Abdomen in A Woman Caused by Torsion of Pedunculated Subserosal Myoma: A Case Report and Literature Review

Background: Torsion of pedunculated subserosal myoma is a clinically rare but potentially life-threatening disease. In patients with acute abdomen, fibroid pedicle torsion is not a routine differential diagnosis. If not timely identified and treated, fibroid torsion can lead to avascular necrosis and peritonitis. However, relevant publications have so far only been single case reports with a lack of systematic review to summarize clinical features and experience. Case presentation: A 48-year-old woman complained of lower abdominal pain for two weeks and was initially treated as acute pelvic inflammatory disease. The patient’s inflammatory indicators returned to normal but abdominal pain persisted. Considering a pelvic mass found by imaging examination and persistent abdominal pain, a diagnostic laparoscopy was performed, which demonstrated torsion of a pedunculated subserosal myoma. The subserosal myoma and the other two fibroids were removed, and the abdominal pain was completely relieved after surgery. Postoperative pathology confirmed uterine leiomyoma with infarction. Conclusions: Abdominal pain is the most common symptom of leiomyoma torsion. MRI shows higher accuracy and is highly recommended for preoperative diagnosis of myoma torsion. Regardless of pregnancy status, surgery is the first choice of treatment.