Surgical challenges in unusual fibroids - a case series

Abstract

Uterine leiomyoma are benign monoclonal tumours arising from smooth muscle tissue. There are different types of fibroids depending on the location of fibroid. There are various operative challenges in long standing huge fibroids on abnormal location. Surgical difficulties associated with these cases are due to poor access to the operative field, distorted anatomy, difficulty in suturing the repairs, increased blood loss. It is an art and skill to surgically remove these difficult fibroids and do difficult hysterectomies. Here we present case series of 7 cases, we have described variety of fibroid at different ages, presentations, precautions and also surgical challenges and the steps to overcome them successfully. Case 1- cervical fibroid, case 2- submucosal fibroid polyp, case 3- Bulky uterus with fundal fibroid during vaginal hysterectomy, case 4- broad ligament fibroid, case 5- multiple fibroids, case 6- multiple subserosal fibroids during caesarean section, and case 7- giant fibroid. Different types of fibroids are tackled in different ways. So, fibroid mapping by imaging studies and also ureteric stenting preoperatively whenever needed, helps to prevent untoward injuries. Following principles of surgery in any difficult fibroids leads to successful management and also helps to prevent injuries to the urinary tract and avoiding intra operative blood loss.