Giant Cervical Fibroid: A Surgical Challenge

Abstract

Leiomyomas are the most common pelvic tumors, cervical uterine myoma being rare of all uterine fibroids with an incidence of 0.6% of all fibroids. Based on their location, cervical myomas can be classified as extra cervical (sub-serosal myoma) and intracervical. Cervical fibroids can further be anterior, posterior, lateral, and central depending on their position. The surgical treatment of cervical leiomyomas poses more difficulty; due to the risk of intraoperative Hemorrhage and the potential injuries because of contiguity and dislocation of adjacent organs. We present the case of a 46-year-old female, presenting with pain abdomen and abdominal distension. Contrast enhanced-magnetic resonance imaging showed a giant cervical myoma. Enucleation of myoma was done followed by total abdominal hysterectomy with bilateral salpingectomy. Injury to the ureter can be avoided with preoperative cystoscopy-guided bilateral ureteral stenting, intraoperative tracing of the ureter before applying a clamp, and dissection inside the fibroid capsule.

Currently Available Treatment Modalities for Uterine Fibroids

“…Approximately one-third of all hysterectomies worldwide are performed due to uterine fibroids. However, it is an advisable option only for women who have finished their reproduction and are content with losing their uterus [ 94 , 95 ].…”

Large Extracervical Posterior Pedunculated Leiomyoma of the Uterus With the Only Symptom of Chronic Low Back Pain From Radiculopathy: A Case Report

“…Significant intraoperative blood loss due to increased cervical blood perfusion, inadequate surgical plan, and increased risk of bladder, rectal, or ureteral injury are complications that often occur in the surgical treatment of cervical leiomyomas [7,14]. Ureteral injury can be prevented by preoperative bilateral placement of ureteral stents, which allow safe intraoperative ureter dissection and avoid injury from surgical maneuvers while attempting to resect the mass [15]. In addition, preoperative treatment with a GnRH agonist, intraoperative intramyometrial injection of vasopressin, temporary uterine artery occlusion, permanent bilateral ligation of the uterine arteries, and the use of an internal iliac artery balloon occlusion catheter are useful to include in procedures required to prevent intraoperative hemorrhage in the treatment of cervical leiomyomas [16,17].…”