Korean J Obstet Gynecol.  2010 Dec;53(12):1136-1140. 10.5468/kjog.2010.53.12.1136.

Endometriosis and myoma concurrently arising after laparoscopic subtotal hysterectomy

• Kim YA

• KMID: 2037516
• DOI: http://doi.org/10.5468/kjog.2010.53.12.1136

Abstract

Iatrogenic endometriosis and leiomyoma are rare complication of laparoscopic subtotal hysterectomy. I experienced a case of pelvic endometriosis and leiomyoma concurrently arising after laparoscopic subtotal hysterectomy 2 years ago. The patient was a 43-year-old woman, and her chief complaint was palpable mass with pelvic pain in pelvis. Contrast-enhanced computed tomography image showed multiple well enhanced masses. She underwent laparoscopic surgery which revealed pelvic endometriosis and leiomyomas. The solid masses in cul-de-sac and on the surface of rectum were revealed endometriosis. The solid masses on the surface of anterior abdominal wall and descending colon were revealed leiomyoma. Implantation of viable endometrial and leiomyoma tissues could occur during uterine morcellation at time of laparoscopic subtotal hysterectomy in some patients. Vigorous irrigation and meticulous inspection should be performed.

Keyword

Pelvic endometriosis; Leiomyoma; Laparoscopic subtotal hysterectomy; Electric morcellator

MeSH Terms

Abdominal Wall
Adult
Colon, Descending
Endometriosis
Female
Humans
Hysterectomy
Laparoscopy
Leiomyoma
Myoma
Pelvic Pain
Pelvis
Rectum

Figure

• 

  Fig. 1 Showed the echogenic mass (4.1×3.9×2.8 cm) (A) with blood flow (B) in cul-de-sac.

• 

  Fig. 2 Contrast-enhanced computed tomography image showed well enhanced masses in cul-de-sac (A) and on the surface of rectum (B), anterior abdominal wall (C), and descending colon (D).

• 

  Fig. 3 A laparoscopic view of cul-de-sac. Pelvic mass (arrows) were noted in cul-de-sac.

Reference

1. Donnez J, Nisolle M. Laparoscopic supracervical (subtotal) hysterectomy (LASH). J Gynecol Surg. 1993. 9:91–94.

2. Lyons TL. Laparoscopic supracervical hysterectomy. A comparison of morbidity and mortality results with laparoscopically assisted vaginal hysterectomy. J Reprod Med. 1993. 38:763–767.

3. Donnez J, Nisolle M, Smets M, Polet R, Squifflet J. Donnez J, Nisolle M, editors. LASH: laparoscopic subtotal hysterectomy. An atlas of operative laparoscopy and hysteroscopy. 2001. 2nd ed. New York: Parthenon Pub. Group;233–241.

4. Schneider A. Recurrence of unclassifiable uterine cancer after modified laparoscopic hysterectomy with morcellation. Am J Obstet Gynecol. 1997. 177:478–479.

5. Sepilian V, Della Badia C. Iatrogenic endometriosis caused by uterine morcellation during a supracervical hysterectomy. Obstet Gynecol. 2003. 102:1125–1127.

6. Donnez O, Squifflet J, Leconte I, Jadoul P, Donnez J. Posthysterectomy pelvic adenomyotic masses observed in 8 cases out of a series of 1405 laparoscopic subtotal hysterectomies. J Minim Invasive Gynecol. 2007. 14:156–160.

7. Kitawaki J, Noguchi T, Amatsu T, Maeda K, Tsukamoto K, Yamamoto T, et al. Expression of aromatase cytochrome P450 protein and messenger ribonucleic acid in human endometriotic and adenomyotic tissues but not in normal endometrium. Biol Reprod. 1997. 57:514–519.

8. Wilson H, Shaxted EJ. Implantation endometrioma at port site after laparoscopic abdominal supracervical hysterectomy. Gynaecol Endosc. 1999. 8:245–247.

9. Park SY, Choi JY, Baek MS, Koh SB, Lee TS, Choi YS. Disseminated peritoneal leiomyomatosis arising after laparoscopic myomectomy. Korean J Obstet Gynecol. 2010. 53:546–550.

10. Miyake T, Enomoto T, Ueda Y, Ikuma K, Morii E, Matsuzaki S, et al. A case of disseminated peritoneal leiomyomatosis developing after laparoscope-assisted myomectomy. Gynecol Obstet Invest. 2009. 67:96–102.