Introduction: Uterine torsion is defined by a vertical rotation of more than 45 degrees around its cervical-isthmic axis. It is a rare emergency with serious complications that can be life-threatening for the fetus and the mother. Its pathophysiology has not yet been fully explained but this situation is generally the result of a several factors with mainly the asymmetry of the transverse diameter of the uterus and pelvic adhesions.

Case Presentation: We hereby report the case of a 26-year-old female patient, third gesture fourth pare without particular medical history, who presented to the emergency department at 37 weeks of amenorrhea of a twin pregnancy with severe abdominal pain of sudden onset. Initially mistaken for retroplacental hemorrhage or uterine rupture, it was only in the pre operatory phase of an emergency cesarean section that the diagnosis of uterine torsion was made. The operation was complicated by postpartum hemorrhage due to uterine atony which was managed by prompt medical care and a triple Tsirulnikov ligation. She was discharged home with her two healthy newborns at D4 post-op.

Conclusion: Uterine torsion is an uncommon and serious obstetric complication of difficult diagnosis that can be life-threatening for the fetus and the mother. The specificity of our case is twofold. Firstly, it is the third case of uterine torsion in twin pregnancy reported in the literature to date. Secondly, it is the first time to our knowledge that the difference in length of the two round ligaments is observed as a possible factor in the pathophysiology of this complication.