PMC8721407_01
(a) A sagittal T2-weighted magnetic resonance image (MRI) showing multiple pedunculated subserosal uterine leiomyomas with calcifications. (b) A coronal T2-weighted MRI revealing the "whirl sign" of the uterine cervix.
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Subsequently, contrast-enhanced magnetic resonance imaging (MRI) revealed multiple subserosal uterine leiomyomas with calcifications (Figure 1(a)); peritonitis was similarly suspected. In retrospect, the MRI findings implied uterine torsion, considering the "whirl sign" of the uterine cervix (Figure 1(b)).
(a) Findings from laparotomy. Multiple pedunculated subserosal uterine leiomyomas with calcification are identified, and the uterus is rotated 90  counterclockwise. The uterine body and bilateral uterine adnexa appear to be congested and necrotic. (b) Stalks of the subserosal uterine leiomyomas appear to twine around the junction between the cervix and the uterine body and pulled the uterine body counterclockwise. (c) Resected uterus and both adnexa. Three pedunculated subserosal uterine leiomyomas (3-6 cm) arising near the tubal cornua are observed. The right adnexa and uterine body are stretched and seem to be both congested and necrotic.
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The uterine body and bilateral uterine adnexa appeared congested and necrotic (Figure 2(a)). The stalks of the pedunculated subserosal uterine leiomyomas appeared to wrap around the junction between the uterine cervix and body, pulling the uterine body counterclockwise (Figure 2(b)). In addition, the right side of the uterine body was particularly stretched (Figure 2(c)).