Uterine torsion with concurrent uterine dehiscence in the third trimester of pregnancy.

Uterine torsion is a rare but potentially life-threatening obstetric complication. We report the case of a gravida III, para II woman with a history of two prior caesarean deliveries who presented at 28+4 weeks of gestation with localised left-sided abdominal pain, raising suspicion of uterine dehiscence. Ultrasound and MRI could not provide a definitive diagnosis of uterine rupture, despite demonstrating focal thinning of the lower uterine segment. Due to worsening symptoms, a caesarean delivery was performed at 30+5 weeks. Intraoperatively, a 90° uterine dextrotorsion with concurrent uterine dehiscence was identified. Appropriate surgical management resulted in favourable maternal and neonatal outcomes. This case underscores the limitations of imaging and highlights the importance of maintaining clinical suspicion and performing systematic intraoperative assessment in pregnant patients presenting with atypical abdominal pain.