504 Non-Gravid Uterine Torsion Associated with Small Bowel Obstruction

Uterine torsion is an uncommon condition. Even more so in cases of non-gravid torsion. We present the case of a postmenopausal woman in her 70’s who arrived to our emergency department with hypoxic respiratory failure and hypovolemic shock requiring prompt resuscitation with non-invasive ventilation and intravenous crystalloids following 4 day history of abdominal pain and vomiting. Abdominopelvic Computed tomography demonstrated a small bowel obstruction secondary to a large palpable uterus. Diagnosis was made of small bowel obstruction secondary secondary to a large leimyomatous uterus associated with acute kidney injury and aspiration pneumonia. Laparotomy demonstrated a large leimyomatous uterus that had torted on the cervical pedicle associated with perforation of the lower anterior segment. A segment of healthy jejunum was adhered to the uterine fundus and was easily mobilised with blunt dissection. Hysterectomy and bilateral oophorectomy were performed. The patient made a full recovery. Histopathology demonstrated a calcified leiomyomatous uterus with adjacent haemorrhagic infarction of the uterine wall. This is the first case of small bowel obstruction associated with uterine torsion identified in the literature. Uterine Torsion is defined as a more than 45-degree rotation around the long axis of the uterine body. The most common cause of uterine torsion relates to pregnancy, or abnormal foetal presentation. Non gravid causes include Leiomyoma, uterine abnormalities such as bicornuate uterus, pelvic adhesions, or adnexal masses. On CT/MRI the whirl/whorl sign of the uterine cervix is indicative of uterine torsion however this was not present in our case, and diagnosis was only made intra-operatively .