Port site parasitic leiomyoma after laparoscopic myomectomy: a case report and review of the literature

Abstract

BackgroundUterine fibroids are the commonest benign gynecological tumors. Laparoscopic myomectomy is becoming increasingly popular as one of the surgical treatment options for symptomatic cases. Large tissues such as leiomyomas or even the uterus need to be morcellated in order to be retrieved from the abdominal cavity. Some of the morcellated fragments or small fibroids may be accidentally left in the abdominal cavity during the retrieval process. These may subsequently become implanted in the abdominal cavity, develop blood supply from the surrounding structures, and grow to form parasitic myomas with varied clinical presentation, depending on the location and size.Case presentationA 47-year-old African woman presented to our hospital 6 years after laparoscopic myomectomy with a lower abdominal mass. Her work-up revealed an anterior abdominal wall mass consistent with uterine leiomyoma. She was scheduled for excision of the mass, which was subsequently histologically confirmed to be a uterine fibroid.ConclusionsParasitic leiomyomas are a rare late complication of power morcellation following laparoscopic myomectomy or hysterectomy. Most patients present with an abdominal/pelvic mass and may need surgical excision to relieve the symptoms. Care should be taken during power morcellation to prevent excessive fragmentation of the tissues, some of which may become implanted and persist to form parasitic myomas. Moreover, effort should be made to retrieve all myoma fragments by carefully checking the abdominal cavity. Whenever possible, the morcellation should be done in a containment bag.

Emerging complication of laparoscopic power morcellation: a rare case of parasitic leiomyoma

“…It has a quite nonspecific clinical presentation depending on the site of recurrence. Commonest sites include the pelvic cavity/wall, rectum, vagina or cervical stump, caecum, small intestine and laparoscopic port site 7 . In our patient it was found at the right hypochondrial region just underneath the liver.…”

“…Various techniques have been suggested to reduce the incidence of parasitic fibroids. Power morcellation in to a containment bag (Endo Bag) reduces spread of the morcellated fragments 7 . However, morcellation should be avoided in the case of a suspected malignancy.…”

Spontaneous Parasitic Fibroid with Omental Vessel: A Case Report and Literature Review

“…Mostly etiology is not well understood [2,7]. One of the possibility is post laparoscopic removal of uterine fibroid [1,8,9]. Commonly they may not be symptomatic.…”

“…Mostly diagnosis is incidental. However symptoms are in relation with the size, location, numbers and the attached structure [8]. The common symptoms include abdominal distension, abdominal pain, pelvic pain and pressure symptoms [2,10].…”

“…The common symptoms include abdominal distension, abdominal pain, pelvic pain and pressure symptoms [2,10]. Diagnosis could be assisted by imaging such as ultrasonogram, Computed tomography (CT scan) and Magnetic Resonance Imaging (MRI) [3,8]. Management is generally surgical ligation of feeding blood vessel and removal of parasitic myoma [10].…”