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International Journal of Advances In Case Reports

Volume 11, Issue 1, 2024
Mcmed International
International Journal of Advances In Case Reports
Issn
XXX-XXXX (Print), 2349 - 8005 (Online)
Frequency
bi-annual
Email
editorijacr@mcmed.us
Journal Home page
http://mcmed.us/about/ijacr
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Abstract
Title
FIBROID TORSION: AN UNCOMMON CAUSE OF ABDOMINAL PAIN
Author
Marc Wuerdeman, Matthew Grant, Juan Mendoza, David Nguyen DO
Email
marc.f.wuerdeman.mil@mail.mil
keyword
Abstract
Uterine fibroids are the most common gynecologic tumors, clinically apparent in 25%percent of reproductive aged women, and found in 80% of surgically excised uteri. Althoughusually asymptomatic, acute torsion of a fibroid can be a surgical emergency. Patients oftenpresent with severe abdominal pain caused by ischemia after torsion of the vascular pedicle.Only a handful of cases are reported, but the prevalence would suggest it is more common.A 43 year-old female, with no significant history, presented to the EmergencyDepartment with 24 hours of acute onset, severe, left lower abdominal pain.Ovarian torsion was ruled out with a transvaginal ultrasound. CT showed a fibroid uterus,and a hypoattenuating, heterogeneous soft tissue density within the left adnexa. Gynecologytook the patient for laparoscopy and discovered a pedunculated fibroid torsed on its pedicle. Thepatient underwent myomectomy and has been asymptomatic since. Initial imaging workup for suspected fibroid torsion should begin with ultrasound,although the pedicle may be too thin for identification. Case reports have advocated for both CTand MRI in the evaluation of fibroid torsion. Often definitive diagnosis will not be made untilsurgery. Utilizing imaging early in the workup can help exclude other differential pathologies.
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