Giant uterine leiomyomas: dilemmas in surgical management

Abstract

Giant fibroids are very rare in current practice, posing a management challenge. Careful consideration of the benefits and limitations of each treatment option must be considered. This article summarises current management of giant leiomyomas, with a clinical case example and recent review of the literature.

Giant Uterine Leiomyoma With Surgical Difficulty

“…After considering the size of the mass and its high ovarian malignant risk, a laparotomy was planned with the assistance of a digestive surgeon and urologist. This patient's treatment was consistent with the literature on giant uterine leiomyoma management, in which the management option depends on other factors, which include age, type of lesion, severity of symptoms, malignancy probability, and fertility conservation [9,10]. Indications for surgical management include abnormal uterine bleeding that does not resolve after conservative treatment, secondary iron deficiency to chronic bleeding anemia, severe abdominal pain due to mass compression that reduce the patient's quality of life, and suspicion of malignancy.…”

“…Surgical management of this patient's tumor (diameter > 25 cm) was challenging due to massive blood loss caused by increased vascularization and possibilities of post-operative complications, which include trauma of urinary tract or gastrointestinal infection, and hematoma. Pre-operative assessment of the patient must be performed thoroughly, in order to prevent possible intra-operative and post-operative complications [7,9]. Proper skin excision has to be performed in order to effectively manipulate the mass and examine the upper abdominal region [4,9].…”

“…Pre-operative assessment of the patient must be performed thoroughly, in order to prevent possible intra-operative and post-operative complications [7,9]. Proper skin excision has to be performed in order to effectively manipulate the mass and examine the upper abdominal region [4,9]. En-bloc evacuation reduces bleeding risk.…”

“…Potential bleeding sources include collateral circulation, arterio-venous shunting, and tumor size must be properly managed, since it is prone to hypovolemic shock due to anemia and poor nutritional status. Pelvic anatomical distortion due to uterine abnormality may increase injury risk in adjacent gastrointestinal and urinary structures [9].…”

Surgical challenges in unusual fibroids - a case series

“…The surgical management of large tumours, as in our case, can be a challenge even when the open surgical approach is chosen, and again in these cases a laparoscopic method is not recommended. 19 Preoperative assessment should be meticulous, in order to avoid intra-operative and post-operative complications.…”