Abstract
Clinicians should consider uterine torsion as a differential diagnosis for acute abdominal pain in women with scoliosis. Scoliosis may have led to an abnormal pelvic structure, making it easier for pelvic organs to twist.
Keywords: abdominal pain, scoliosis, uterine torsion
Clinicians should consider uterine torsion as a differential diagnosis for acute abdominal pain in women with scoliosis. Scoliosis may have led to an abnormal pelvic structure, making it easier for pelvic organs to twist.
1. QUESTION
What is the differential diagnosis of abdominal pain with scoliosis?
2. ANSWER
A differential diagnosis of sudden abdominal pain with scoliosis indicates uterine torsion, a rare condition in clinical practice.
3. MANUSCRIPT
A 73‐year‐old woman with a history of infantile paralysis and scoliosis presented with sudden abdominal pain. Physical examination revealed a palpable mass in the lower abdomen. X‐ray revealed severe scoliosis (Figure 1). Contrast‐enhanced CT showed a uterine mass (20 cm) across its widest dimension without enhancement effect and cervical torsion (Figure 2). We observed a 5‐cm‐sized left ovarian tumor and a 10‐cm‐sized right ovarian tumor.
FIGURE 1.
X‐ray of the abdomen indicates severe scoliosis
FIGURE 2.
CT of the abdomen and pelvis shows torsion of the cervix (arrow)
Based on the preoperative diagnosis of either side of ovarian torsion, total hysterectomy and bilateral salpingo‐oophorectomy were performed. Intraoperatively, the uterus appeared mostly necrotic and twisted by 180º (Figure 3). The uterine and bilateral ovarian tumors were in the right pelvis at the abnormal deep portion where the spine had curved. Histopathological analysis revealed uterine leiomyomas with congestive necrosis and bilateral ovarian serous cystadenoma. Her postoperative course was uneventful.
FIGURE 3.
Laparotomy reveals the mostly necrotic uterus twisted 180º
Uterine torsion, defined as >45º twisting of the uterus on its long axis, is rare.1 Cases of volvulus with scoliosis and uterine torsion with ovarian cyst have been reported.2, 3 Our case may illustrate the association between uterine torsion and scoliosis. Scoliosis may have led to an abnormal pelvic structure, making it easier for the massive uterus and ovarian tumors to twist.
ACKNOWLEDGMENTS
The authors would like to thank the patient for giving consent.
CONFLICT OF INTEREST
None declared.
AUTHOR CONTRIBUTIONS
KK provided case information, references, and wrote the manuscript. FK and IY provided case information and clinical images.
ETHICAL APPROVAL
Standard ethical approval was obtained.
CONSENT
Published with written consent of the patient.
Kamijo K, Kubota F, Yoshioka I. Uterine torsion with scoliosis. Clin Case Rep. 2021;9:e04818. 10.1002/ccr3.4818
Funding information
This research did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
REFERENCES
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.