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Dr. Poonam Khera

Dr. Poonam Khera
Sr. Consultant
Gynaecology & Obstetrics
BLK Super Speciality
Hospital, New Delhi

Dr. Kanika Garg

Dr. Kanika Garg
Attending Consultant
Gynaecology & Obstetrics
BLK Super Speciality
Hospital, New Delhi






A Single and Simple Solution

A rare case of multiple parasitic fibroids

Uterine Fibroids are one of the most common tumours found in women of the reproductive age group. Parasitic or wandering fibroids are very rare type of Uterine Fibroids. Due to its rarity, atypical clinical presentation and unusual location, it becomes challenging to reach correct diagnosis pre-operatively. Recently, incidence of secondary parasitic leiomyomas has increased as a complication of Laparoscopic Myomectomy and Morcellation.

THE CASE

A 35-year old unmarried female got admitted in BLK Super Speciality Hospital with complaints of abdomen pain and generalised weakness for 3 days. CT abdomen revealed multiple solid, non-necotic intraperitoneal masses with small bowel obstruction. The patient’s CA- 125 was 14.7. Cytology from the mass revealed reactive mesothelial cells and trucut biopsy of intraperitoneal mass in RIF region revealed leiomyoma. The patient had a history of Laparoscopic Myomectomy with Morcellation a few years back.

THE PROCEDURE

The patient was taken up for Exploratory Laparotomy. Multiple parasitic fibroids (13 in number) in relation with the bowel, mysentery and parietal wall of variable sizes from 1 cm to 8 cm were carefully removed by the Gastrointestinal Surgery team. Excision of fibrous band from parietal wall of jejunum was also done. The whole gut loops was examined to exclude any small fibroid. The uterus was enlarged to 16- 18 weeks due to multiple fibroids. 11 fibroids of variable sizes (1 cm to 6 cm), both intramural and subserosal were removed from the uterus.

THE RESULT

The post-operative period was uneventful. She was discharged on normal diet and regular bowel movements.

Thus, the key to appropiate management lies in keeping parasitic fibroids in mind as there are differential diagnosis of abdominopelvic masses in females, especially with a history of Laparoscopic Myomectomy.