Postmenopausal Uterine Torsion with Hemorrhagic Shock Mimicking a Giant Ovarian Tumor: A Case Report.

Background: Postmenopausal uterine torsion is an extremely rare gynecological emergency that is often challenging to diagnose preoperatively because of its atypical presentation. This case is particularly noteworthy for a 10-year history of an untreated abdominal mass that rapidly evolved into a life-threatening condition, along with a striking discrepancy between the initial imaging suspicion and the final pathological diagnosis. Case Presentation: A 75-year-old Asian woman presented with chronic abdominal distension for 10 years and acutely worsening severe generalized abdominal pain for 1 day. Contrast-enhanced computed tomography (CT) revealed a huge pelvic mass initially misinterpreted as a giant ovarian tumor. The patient's condition deteriorated rapidly into hemorrhagic shock. Emergency exploratory laparotomy confirmed a 720° clockwise uterine torsion. Total hysterectomy with bilateral salpingo-oophorectomy was performed without detorsion. Postoperative histopathology confirmed multiple uterine leiomyomas (lipoleiomyoma with extensive hemorrhagic necrosis). The patient recovered uneventfully. Conclusion: Although rare, postmenopausal uterine torsion should be considered in the differential diagnosis of acute abdomen in elderly women with known pelvic masses. Timely emergency surgery is life-saving, especially in those presenting with hemorrhagic shock. This case underscores the importance of regular clinical and ultrasound follow-up for postmenopausal women with known giant uterine masses, even when asymptomatic.