Double simultaneous torsion: A case report of concurrent torsion of the right adnexa and a right round ligament fibroma.

INTRODUCTION AND IMPORTANCE: Round ligament leiomyomas (RLL) are uncommon benign tumors of the pelvic region. When torsion occurs, it can lead to acute or chronic pelvic pain and potentially severe complications such as gangrene, peritonitis, hemoperitoneum, and shock if not promptly diagnosed and treated. Torsion of the adnexa and torsion of round ligament fibromas are rare gynecological emergencies, and their simultaneous occurrence is exceedingly uncommon. This report highlights what appears to be the first documented case of double torsion involving both the right adnexa and a round ligament fibroid, emphasizing its clinical significance and diagnostic challenges.

CASE PRESENTATION: We describe a rare case of a leiomyoma of the round ligament that was preoperatively misdiagnosed as a large malignant ovarian tumor. The patient presented with chronic pelvic pain progressing to acute exacerbation and abdominal bloating. She was found to have simultaneous torsion of the right adnexa and torsion of the round ligament fibroid. The adnexal torsion involved the right ovary and fallopian tube, complicating the clinical picture. Imaging studies and diagnostic tools were utilized, leading to a complex diagnostic process. Surgical intervention was performed to manage the condition, and the postoperative course was uneventful.

CLINICAL DISCUSSION: The simultaneous torsion of the adnexa and a round ligament fibroid presents a significant diagnostic challenge due to overlapping clinical and imaging findings with other pelvic pathologies, particularly malignancies. Misdiagnosis can lead to delays in treatment and worsen outcomes. This case highlights the importance of considering rare pathologies like round ligament torsion in patients presenting with acute or chronic pelvic pain, especially in the presence of complex imaging findings. Early recognition and timely surgical intervention are critical to prevent severe complications such as gangrene and peritonitis.

CONCLUSION: Double torsion involving the adnexa and a round ligament fibroid is an extremely rare and complex clinical scenario. This case underscores the need for heightened awareness and careful diagnostic evaluation of pelvic pain in women, as prompt surgical management is essential to avoid life-threatening complications. Further studies are warranted to better understand and manage this unusual combination of pathologies.