Obstet Gynecol Sci.  2016 Jan;59(1):75-78. 10.5468/ogs.2016.59.1.75.

Torsion of a parasitic myoma that developed after abdominal myomectomy

• Cho IA
• Baek JC
• Park JK
• Song DH
• Kim WJ
• Lee YK
• Park JE
• Shin JK
• Choi WJ
• Lee SA
• Lee JH
• Paik WY

• KMID: 2152650
• DOI: http://doi.org/10.5468/ogs.2016.59.1.75

Abstract

Iatrogenic parasitic myomas are rare. The condition is defined by the presence of multiple smooth-muscle tumorous nodules in the peritoneal cavity. This may be attributable to seeding of myoma particles during uterine surgery. The clinical course is usually indolent. The disease is often asymptomatic and is usually discovered only incidentally. A 38-year-old woman who had undergone abdominal myomectomy 7 months prior presented with acute abdominal pain and a huge pelvic mass. We performed exploratory laparotomy. A parasitic mass 17 cm in diameter with a twisted omental pedicle was identified. En bloc excision of the mass and omentum was performed, followed by total abdominal hysterectomy. Histopathological examination of multiple sections revealed features compatible with an infarcted leiomyoma. Thus, we present a very rare case of an iatrogenic, rapidly growing parasitic myoma complicated by omental torsion (which caused the acute abdominal pain). We also offer a literature review.

Keyword

Abdominal pain; Omental torsion; Parasitic myoma

MeSH Terms

Abdominal Pain
Adult
Female
Humans
Hysterectomy
Laparotomy
Leiomyoma
Myoma*
Omentum
Peritoneal Cavity

Figure

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  Fig. 1 Preoperative computed tomography imaging of the mass. (A) Axial and (B) coronal computed tomography reveal a well-defined, lobulated heterogeneous mass in the lower abdomen.

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  Fig. 2 (A) Coronal computed tomography showing a twisted omentum. These findings are consistent with the operative findings (white arrows). (B) An intra-operative photograph shows the omental mass connected to a twisted vascular pedicle (black arrows).

Reference

1. Cucinella G, Granese R, Calagna G, Somigliana E, Perino A. Parasitic myomas after laparoscopic surgery: an emerging complication in the use of morcellator? Description of four cases. Fertil Steril. 2011; 96:e90–e96.

2. Sinha R, Hegde A, Mahajan C, Dubey N, Sundaram M. Laparoscopic myomectomy: do size, number, and location of the myomas form limiting factors for laparoscopic myomectomy? J Minim Invasive Gynecol. 2008; 15:292–300.

3. Kho KA, Nezhat C. Parasitic myomas. Obstet Gynecol. 2009; 114:611–615.

4. Tan CH, Ho BC, Shelat V, Tan CH. Leiomyomatosis peritonealis disseminata presenting as omental torsion. Singapore Med J. 2012; 53:e71–e73.

5. Ryan GL, Syrop CH, Van Voorhis BJ. Role, epidemiology, and natural history of benign uterine mass lesions. Clin Obstet Gynecol. 2005; 48:312–324.

6. Wallach EE, Vlahos NF. Uterine myomas: an overview of development, clinical features, and management. Obstet Gynecol. 2004; 104:393–406.

7. Kelly HA, Cullen TS. Myomata of the uterus. Philadelphia (PA): Saunders;1909.

8. Brody S. Parasitic fibroid. Am J Obstet Gynecol. 1953; 65:1354–1356.

9. Nezhat C, Kho K. Iatrogenic myomas: new class of myomas? J Minim Invasive Gynecol. 2010; 17:544–550.

10. Brolmann H, Tanos V, Grimbizis G, Ind T, Philips K, van den Bosch T, et al. Options on fibroid morcellation: a literature review. Gynecol Surg. 2015; 12:3–15.

11. Larrain D, Rabischong B, Khoo CK, Botchorishvili R, Canis M, Mage G. "Iatrogenic" parasitic myomas: unusual late complication of laparoscopic morcellation procedures. J Minim Invasive Gynecol. 2010; 17:719–724.

12. Huang PS, Chang WC, Huang SC. Iatrogenic parasitic myoma: a case report and review of the literature. Taiwan J Obstet Gynecol. 2014; 53:392–396.

13. Ramesh B, Sharma P, Gunge D. Abdominal wall parasitic myoma following electromechanical morcellation. J Obstet Gynaecol India. 2014; 64:Suppl 1. 73–75.

14. Rajab KE, Aradi AN, Datta BN. Postmenopausal leimyomatosis peritonealis disseminata. Int J Gynaecol Obstet. 2000; 68:271–272.

15. Park CM, Kim SY. Primary omental torsion diagnosed during hysterectomy. Obstet Gynecol Sci. 2014; 57:415–418.