Sigmoid Volvulus, Intestinal Obstruction and Bowel Perforation;an Unusual Presentation of Pedunculated Fibroid Torsion. Case Report  

作　　者：Emmanuel Mamah Azubuike Onyebuchi Chichetaram Otu Nnaemeka Egbuonu Parakrama Happawana Emmanuel Mamah;Azubuike Onyebuchi;Chichetaram Otu;Nnaemeka Egbuonu;Parakrama Happawana(Department of Obstetrics and Gynaecology, Homerton University Hospital NHS Foundation Trust, London, UK;Federal Medical Centre, Umuahia, Nigeria;Government House Clinic, Abakaliki, Nigeria;Queens Hospital, Romford, Essex)

机构地区：[1]Department of Obstetrics and Gynaecology, Homerton University Hospital NHS Foundation Trust, London, UK [2]Federal Medical Centre, Umuahia, Nigeria [3]Government House Clinic, Abakaliki, Nigeria [4]Queens Hospital, Romford, Essex

出　　处：《Case Reports in Clinical Medicine》2021年第10期308-313,共6页临床医学病理报告（英文）

摘　　要：Pedunculated fibroid torsion presenting as a case of acute abdomen from sigmoid volvulus and large bowel perforation is rare. Without prompt diagnosis and intervention, this could lead to serious morbidity and mortality. Ms FM was a 52-year-old perimenopusal woman who was admitted to the Intensive Therapy Unit (ITU) with worsening symptoms of confirmed Covid-19 infection. On the 10th day of her admission, she developed abdominal distension and tenderness. A pelvic ultrasound scan showed a large pedunculated fibroid measuring 23 × 15 × 22 cm. The plan was for conservative management to use pain killers. Following deterioration of her clinical state, an abdominal CT scan was done which confirmed a large uterine fibroid, large bowel distention. CT findings also showed sigmoid volvulus and large bowel perforation. Following a multidisciplinary team assessment, she had an emergency exploratory laparotomy with findings of a large, torted, pedunculated fibroid with adherent sigmoid colon which had become twisted and obstructed. The large bowel segment above the Sigmoid volvulus was grossly distended and there was a gangrenous hepatic flexure with perforation. She had a right hemicolectomy, a de-functioning colostomy and subtotal hysterectomy. Postoperatively, she made very good clinical improvement. Fibroid histology report showed tissue infarction and necrosis which confirmed the torsion. She was discharged home after making good recovery.Pedunculated fibroid torsion presenting as a case of acute abdomen from sigmoid volvulus and large bowel perforation is rare. Without prompt diagnosis and intervention, this could lead to serious morbidity and mortality. Ms FM was a 52-year-old perimenopusal woman who was admitted to the Intensive Therapy Unit (ITU) with worsening symptoms of confirmed Covid-19 infection. On the 10th day of her admission, she developed abdominal distension and tenderness. A pelvic ultrasound scan showed a large pedunculated fibroid measuring 23 × 15 × 22 cm. The plan was for conservative management to use pain killers. Following deterioration of her clinical state, an abdominal CT scan was done which confirmed a large uterine fibroid, large bowel distention. CT findings also showed sigmoid volvulus and large bowel perforation. Following a multidisciplinary team assessment, she had an emergency exploratory laparotomy with findings of a large, torted, pedunculated fibroid with adherent sigmoid colon which had become twisted and obstructed. The large bowel segment above the Sigmoid volvulus was grossly distended and there was a gangrenous hepatic flexure with perforation. She had a right hemicolectomy, a de-functioning colostomy and subtotal hysterectomy. Postoperatively, she made very good clinical improvement. Fibroid histology report showed tissue infarction and necrosis which confirmed the torsion. She was discharged home after making good recovery.

关 键 词：Case Report Bowel Perforation Fibroid Torsion Pedunculated Fibroid Sigmoid Volvulus 

分 类 号：O55[理学—热学与物质分子运动论]