UTERINE TORSION AND PRESERVED REPRODUCTIVE FUNCTION: EXTREMELY RARE CASE REPORT
2Gynaecology, Faculty of Additional Federal Education "Moscow State University of Medicine and Dentistry", Moscow
3Gynaecology, Russian Children's Clinical Hospital of the Federal State Autonomous Educational Institution Of Higher Education - Pirogov Russian National Research Medical University Of The Ministry Of Health Of The Russian Federation, Moscow
4Gynaecology, Federal State Autonomous Educational Institution of Higher Education - Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow
5Gynaecology, Morozov Municipal Pediatric Clinical Hospital of the Department of Health, Moscow
6Gynecology, Federal State Budgetary N.I. Pirogov National Medical and Surgical Center, Moscow
A 4-year-old girl was admitted to the Gynecological Department of Children’s Hospital with complaints of moderate pain in the lower abdomen and vomiting. The rectal examination revealed a rounded mass about 7 × 6 cm in size, motionless, sensitive when displaced.
Ultrasound of the pelvic organs revealed: echographic signs of heterogeneous liquid volumetric formation in the projection of left appendages and structural changes in the uterus. Laboratory tests: complete blood count without changes, alpha-fetoprotein (AFP) - 0.65 IU / ml, human chorionic gonadotropin (hCG) - 0.35 mIU / ml, CA-125 - 97.0 U / ml (reference values - 0.0—35.0 U / ml).
MRI conclusion: the tumor of the left uterine appendages.
Intraoperative picture: Laparoscopic access in the pelvic projection revealed a conglomerate consisting of two cyanotic formations. The left adnexal mass is not changed (torsion of the uterus in the isthmus? cervix? 360 degrees), torsion of the right uterine appendages 1440 degrees counterclockwise was revealed. Detorsion of the body of the uterus was performed, the blood flow was partially restored, tissue changes were revealed after torsion in the isthmic part of the fallopian tube and the uterine ligament closer to the corner of the uterus on the left. Detorsion of the right uterine appendages was performed, the adnexal mass was necrotic and led to adnexectomy. Given the partial restoration of blood flow in the body of the uterus, it was decided to reject extirpation of the body of the uterus and to carry out re-laparoscopy in 2-3 days.
During re-laparoscopy: the uterus of normal size. Areas of ischemic changes significantly decreased.
Ultrasound of the pelvic organs on the third day after re-laparoscopy: the topography of the uterus is normal. The histological conclusion: a morphological picture of torsion of the adnexal masses against the background of a dermoid cystoma. The postoperative period was uneventful.
Conclusion: The surgical group managed to save the uterus due to preserved blood flow. To conclude, the discrepancy between the imaging methods and the intraoperative picture in the patient is associated with the difficulties of diagnosing the rarest case of torsion of the uterus in clinical practice.
