A Case of Acute Fibroid Degeneration with Complete Torsion of the Uterus

COMPJ.JETE TORSION OF THB UTERUS ABRAHAM

.J.

FLEIHC'HER,

lVLll.,

,J. IRVING N. Y.

AND

NEW YORK,

KnmNER.

M.D.,

(F1·om the Depm-tment of Obstetrics, The B-ron.r HospUal)

-MRS. I. B., aged forty-five, admitted to The Bronx Hospital because of vaginal l bleeding, lower abdominal pain, nausea, and temperature of 101 o. Family history irrelevant. Past history revealed a similar attack four years ago di!ignosed as appendicitis and treated conservatively. Menstrual periods began at the age of eleven, of the twenty-eight day type with six day flow. No pain. No len~orrhea. Always regular. Para i, gravida i. J<~or the past year periods have in· creased in length and have been associated with the frequent passage of clots. Present illness began two days before atlmission in an intermenstrual veriod, with nausea, abdominal pain and bleeding. Temperature continued to rise. mi'dication gave no l'elief. Examination showed an obese, middle-aged female, awtely ill. Xo jaundice or cyanosis. No dyspnea. Temperature 102.5•, pulse 112, regular and of good quality. Respirations 26. Heart and lungs were negative. Blood pressme 140/90. The lower abdomen was filled with a firm, irregular, nodular mass slightly tender. On vaginal examination this mass was felt as distinct from the uterus. A diagnosis of twisted ovarian cyst or twi~ted fibroid was made and she was removed to the hospital for operation. Under spinal anesthesia, a mid-line incision was maue below the umbilicus, revealing a large fibroid which together with the uterus filled the true pelvis and extended to the right lower quadrant of the abdomen. The uterus was twisted upon its long axis so that the right tube and ovary lay posteriorly and to the left. The left ovary contained a simple parovarian cyst, and was situated anterior and to the right. A supravaginal hysterectomy, bilateral salpingo-oophoredomy and appendicectomy were done. The postoperative dia1,>nosis was degenerating fibroid of the uterus producing torsion and a simple parovarian cyst. The uteru~ wa~ approximately 16 by 15 cn1. The left ovary was atrophic and the seat of a parovarian cyst 4 by 5 em. and containing a clear serous fluid. The entire posterior and right lateral walls of the uterus were occupied by a fim1 fleshy masR showing here and there areas of herndion. The right ovary contained one large lutein cyst. 't'he tubes appeared tu be normal. Section;; showed a leiomyofibroma with areas of anemic autoinfaretion and hyalinization. Patient made a fair recovery, the postoperative eourse being complicated by a right upper bronchopneumonia. SIH' was discharged, weH, on the nineteenth postoperative day. This history demonstrates that extreme toTsions of the uterus must be considl'I'ed in the diagnosis o:f pelvic diseage, pal'ticulnrly ·when fibroid deg·enerati_on has taken place, presenting similar finclings on bimanual examination to that of a twisted ovarian cy~t. 1882 GRAND CoNcou&sE. 215 EAST GUNHILL RoAD.

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