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TITLE: TORSION OF A PEDUNCULATED SUBSEROSAL LEIOMYOMA, A RARE CAUSE OF ACUTE ABDOMEN. PRESENTING AUTHOR: DR KRISHNA H. SISODIYA (JUNIOR RESIDENT, DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY) CO-AUTHOR: DR PRIYANKA KAMBLE (MBBS, MD, FICOG) PROFESSOR, DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY INTRODUCTION: ACUTE ABDOMINAL PAIN CAUSED BY PEDUNCULATED SUBSEROSAL LEIOMYOMA TORSION IS A RARE ENTITY, MISSED DIAGNOSIS CAN LEAD TO PERITONITIS, NECROSIS OR ISCHEMIA WHICH CAUSES SIGNIFICANT MORBIDITY. TORSION OF LEIOMYOMA SHOULD BE RECOGNIZED AS A SURGICAL EMERGENCY AND ONCE SUSPECTED, EARLY SURGICAL INTERVENTION SHOULD BE CONSIDERED. CASE HISTORY: A 31 YEAR OLD NULLIGRAVIDA PATIENT, UNMARRIED WITH NO HISTORY OF CONTACT CAME TO THE CASUALTY OF VEDANTAA INSTITUTE OF MEDICAL SCIENCE WITH COMPLAIN OF SEVERE PAIN IN ABDOMEN WHICH WAS SUDDEN IN ONSET. ON PER ABDOMINAL EXAMINATION, THERE WAS GUARDING AND RIGIDITY AND A MIDLINE SOLID MASS OF APPROXIMATELY 10*10 CM WHICH WAS SUPRAPUBIC IN LOCATION AND FIRM IN CONSISTENCY WAS PALPATED. A COMPUTED TOMOGRAPHY AND ULTRASOUND WAS PERFORMED WHICH DEMONSTRATED A SUBSEROSAL LEIOMYOMA WITH POOR CONTRAST ENHANCEMENT. INTERVENTION: MYOMECTOMY WAS PERFORMED AND THE INTRAOPERATIVE FINDING SHOWED A PEDUNCULATED SUBSEROSAL LEIOMYOMA ON THE ANTERIOR WALL OF UTERUS WITH TORSION BY 180?. UTERUS AND OVARIES WERE DENSELY ADHERED TO THE BOWEL. OUTCOME: THE PATIENT UNDERWENT MYOMECTOMY FOR THE TWISTED PEDUNCULATED SUBSEROSAL LEIOMYOMA AND WAS DISCHARGED WITH A FAVOURABLE OUTCOME. CONCLUSION: TORSION OF LEIOMYOMA IS A SURGICAL EMERGENCY AND DELAY IN TREATMENT MAY LEAD TO MARKED MORBIDITY, ONCE SUSPECTED, THE GYNAECOLOGIST MUST BE CONSULTED AND SURGICAL INTERVENTION SHOULD BE CONSIDERED. KEY WORDS: ABDOMNAL, PAIN. LEIOMYOMA. TORSION.