Torsion of the gravid uterus is very rare in obstetric practice. We report a case of torsion in the uterus didelphys at term which is rare and a lifetime experience for an obstetrician. The patient, a 25-year-old gravida 2 para 1 was admitted to the labor ward at 37 weeks and six days of gestation with abdominal pain. Her previous delivery was a caesarean section performed four years back. She was taken to the operating room for an emergency caesarean section for fetal distress and the lie was transverse. On entering the peritoneal cavity, we found an engorged infundibulopelvic ligament with the fallopian tube and ovary covering the lower segment of the uterus. The baby was successfully delivered by breech extraction. Due to uterine torsion of more than 180 degrees, the posterior surface of the uterus was placed anteriorly, and the incision was made on the posterior surface of the uterus. There was a hemi uterus on the left side of the pelvic cavity with the fallopian tube and ovary attached to it; a diagnosis of uterus didelphys was made. The diagnosis of uterine torsion is intraoperative and prompt and timely decision by surgeons is crucial. We had favorable maternal and fetal outcomes in this rare and interesting case. The diagnosis, though rare, should be kept in mind in all cases of abdominal pain during pregnancy, especially in those with malpresentation.
Keywords: obstetrician; pregnancy; torsion; transverse lie; uterus didelphys.
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