Painless ovarian torsion mimicking a uterine myoma.

OBJECTIVE: Uterine myoma is the most common benign solid pelvic tumor seen in women and is easily demonstrated by pelvic ultrasonography. However, a chronic ovarian torsion with entire necrosis may be an exceptional mimicker. We herein present an unusual case of painless ovarian torsion similar to a subserous uterine myoma.

CASE REPORT: A 35-year-old female virgin presented with a palpable midline pelvic mass that had been present for 2 months. Ultrasound revealed a well-defined, heterogeneous solid mass with echogenic rim that resembled a uterine myoma, 10.9 x 9.9 x 7.3 cm in size, just upon the uterus. Surgical exploration disclosed an enlarged stony ovary and swollen tube that were both twisted. The ovary was clogged up with red meat-like necrotic tissue. The pathologic findings were compatible with ovarian torsion, and subsequent infarction and necrosis.

CONCLUSION: Ovarian torsion is a significant cause of acute lower abdominal pain in women and is a gynecologic surgical emergency. Nevertheless, surgical strategies are usually impeded because of ambiguous warning signs. Clinicians may be misled by certain conditions such as silent ovarian torsion. Although there may be no specific indication, the diagnosis of ovarian torsion should be considered on finding a pelvic mass.