Volume 11, Issue 1 (2026)
SJMR 2026, 11(1): 29-35 |
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Nami F, Sanaye Naderi M, Mohammadian H, Ghaharzadeh Mahabadi M. Case Report of a Rare Multiple-Torsion of Left Adnexa with Necrotic Hematosalpinx and Ovarian Fibroma with Extensive Hemorrhage in a 69-Year-Old Postmenopausal Woman: Diagnostic Challenges in Menopause. SJMR 2026; 11 (1) : 5
URL: http://saremjrm.com/article-1-390-en.html
URL: http://saremjrm.com/article-1-390-en.html
1- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Science (IUMS), Tehran, Iran.
2- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Science (IUMS), Tehran, Iran. & Sarem Cell Research Center (SCRC), Sarem Women’s Hospital, Tehran, Iran.
3- Department of Public Administration, Payame Noor University, Tehran, Iran.
2- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Science (IUMS), Tehran, Iran. & Sarem Cell Research Center (SCRC), Sarem Women’s Hospital, Tehran, Iran.
3- Department of Public Administration, Payame Noor University, Tehran, Iran.
Abstract: (17 Views)
Background: Adnexal torsion in postmenopausal women is rare and its diagnosis is often delayed. This report presents a rare case of multiple-turn torsion of the left adnexa in a 69-year-old postmenopausal woman with a 17-year history of no medical follow-up.
Case Presentation: A 69-year-old woman (G2L2) with a history of two cesarean sections and abdominoplasty presented with acute abdominal pain after 17 years without any medical check-up since menopause. Ultrasonography revealed a right ovarian cyst (95×72×71 mm) and a left uterine fibroid (75–103 mm). MRI demonstrated an anterior-lateral uterine mass (170×127 mm) suggestive of a degenerated fibroid. Tumor markers were within normal limits. During laparoscopy, the left adnexa showed 3–4 turns of torsion accompanied by necrosis and severe hemorrhage. Left salpingo-oophorectomy was performed, and intraoperative frozen section confirmed a benign fibroma. Subsequently, total hysterectomy with right salpingo-oophorectomy was carried out. Final pathology revealed right ovarian fibroma with extensive hemorrhage, serous cystadenoma, and severe necrotic-hemorrhagic hematosalpinx secondary to torsion.
Conclusion: Ovarian torsion can occur even in advanced postmenopausal age (69 years) and in completely benign masses. A 17-year lack of follow-up after menopause was the main factor contributing to delayed diagnosis. Timely laparoscopic surgery using intraoperative frozen section represents a standard and effective approach. This case highlights that adnexal torsion should be considered in any postmenopausal woman presenting with acute abdominal pain and a pelvic mass, even at advanced age.
Case Presentation: A 69-year-old woman (G2L2) with a history of two cesarean sections and abdominoplasty presented with acute abdominal pain after 17 years without any medical check-up since menopause. Ultrasonography revealed a right ovarian cyst (95×72×71 mm) and a left uterine fibroid (75–103 mm). MRI demonstrated an anterior-lateral uterine mass (170×127 mm) suggestive of a degenerated fibroid. Tumor markers were within normal limits. During laparoscopy, the left adnexa showed 3–4 turns of torsion accompanied by necrosis and severe hemorrhage. Left salpingo-oophorectomy was performed, and intraoperative frozen section confirmed a benign fibroma. Subsequently, total hysterectomy with right salpingo-oophorectomy was carried out. Final pathology revealed right ovarian fibroma with extensive hemorrhage, serous cystadenoma, and severe necrotic-hemorrhagic hematosalpinx secondary to torsion.
Conclusion: Ovarian torsion can occur even in advanced postmenopausal age (69 years) and in completely benign masses. A 17-year lack of follow-up after menopause was the main factor contributing to delayed diagnosis. Timely laparoscopic surgery using intraoperative frozen section represents a standard and effective approach. This case highlights that adnexal torsion should be considered in any postmenopausal woman presenting with acute abdominal pain and a pelvic mass, even at advanced age.
Article number: 5
Keywords: Postmenopausal Adnexal Torsion, Ovarian Fibroma, Necrotic Hematosalpinx, Serous Cystadenoma.
Article Type: Case Report |
Subject:
Women Diseases
Received: 2026/05/8 | Accepted: 2026/05/24 | Published: 2026/06/18
Received: 2026/05/8 | Accepted: 2026/05/24 | Published: 2026/06/18
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