Laparoscopic Approach to Fibroid Torsion Presenting as an Acute Abdomen in Pregnancy

Currie, Andrew; Bradley, Elizabeth; McEwen, Marcus; Al-Shabibi, Nawar; Willson, P. D.

doi:10.4293/108680813x13794522666400

Cited by 26 publications

(10 citation statements)

References 16 publications

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“…In the literature, there is no an estimated frequency of the torsion of fibroid because it's an event of exceptional occurrence or an undiagnosed complication. But some described cases of uterine fibroid in twisting are the most observed during pregnancy, especially in the first trimester of pregnancy [2,10,11]. There are risk factors of torsion of pediculated fibroid: mentioned are: the weight of the fibroid, the length of the pedicle, the softening of the fibroid during pregnancy [3,11].…”

Section: Discussionmentioning

confidence: 99%

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Torsion of Uterine Fibroid: A Rare Cause of Acute Pelvic Pain: About One Case

Charles¹,

Kasse²,

Garba³

et al. 2017

Gynecol Obstet Case Rep

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We report a case of torsion of a pedunculated uterine leiomyoma. A 34-year-old housewife has been received at gynaecological emergency department for acute pelvic pain in June 2016. A pelvic ultrasound revealed a uterine with a pedunculated mass. With a preoperative diagnosis of torsion of a pedunculated subserosal leiomyoma, the patient underwent a myomectomy. In conclusion, torsion of a pedunculated uterine myoma is rare but represents a surgical emergency.

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Section: Discussionmentioning

confidence: 99%

“…In our clinical case, symptoms were in relation to the signs described in the literature. The diagnosis of torsion is essentially clinical [10].…”

Section: Discussionmentioning

confidence: 99%

Torsion of Uterine Fibroid: A Rare Cause of Acute Pelvic Pain: About One Case

Charles¹,

Kasse²,

Garba³

et al. 2017

Gynecol Obstet Case Rep

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“…14 Until now, few cases of laparoscopic myomectomy during the second trimester of pregnancy have been reported in the literature. [15][16][17][18] The open Hasson technique was the abdominal entry method, and the site of entry was determined according to location of the myoma and the gestational age of the patient in all reported cases. To our knowledge, this case reports one of the largest myomas ever resected by laparoscopic myomectomy during the second trimester of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…Another method of removing a myoma this large can be by makingPfannenstiel incision as defined in the literature. 18 In our opinion, however, making a Pfannenstielincisionwould decrease the advantages of laparoscopic surgery, which are less post-operative pain and early mobilization during pregnancy.…”

Section: Figure 3: Morcellation Of the Myomamentioning

confidence: 91%

Laparoscopic Resection of a Torsed Big Myoma at 16th Weeks of Gestation

Cırık

Koçak

Ünlübilgin

et al. 2016

Gynecol Obstet Reprod Med

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<p>Myomas are the most common benign tumors of the uterus; however, only 1% to 4% of women were diagnosed with myoma during pregnancy. Although a majority of myomas do not cause any problems during pregnancy and rarely present with torsion or necrosis, myomas might lead to an acute abdomen, which then indicate need for an urgent myomectomy. There are various causes for an acute abdomen during pregnancy, and it is not always easy to make the definitive diagnosis with non-invasive diagnostic tools such as ultrasonography. Because the uterus displaces the intra-abdominal organs during pregnancy, diagnosis of a surgical emergency may be delayed and, consequently, increase maternal morbidity and mortality. If a surgical emergency is indicated, laparoscopy is a safe alternative to laparotomy during pregnancy, requiring a shorter hospital stay and less analgesic; therefore, all surgeons and gynecologists should be able to perform a laparoscopy when needed in each trimester of pregnancy. Herein, we report a 31-year-old primigravid woman presented with an acute abdomen at 16 weeks gestation. Ultrasound examination revealed a nearly 10 cm myoma at the right side of the uterine fundus. Suspecting a torsed myoma, an urgent diagnostic laparoscopy, which revealed a large, torsed, subserous myoma with a 2cm base, was performed. Laparoscopic resection and morcellation was done successfully. No intra-operative or post-operative complications were encountered, and the woman gave birth to a healthy infant at term. By presenting this case, we suggest the safe use of laparoscopic myomectomy of a relatively big myoma even in the second trimester of pregnancy.</p>

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“…In general, myomectomy is not recommended during pregnancy and is not a commonly performed procedure, although it may be considered an option for selected cases. Specifically, the torsion of a pedunculated myoma during pregnancy that could lead to a complete axial torsion of all pregnant tissues should be treated surgically (Deshpande et al 2011;Currie et al 2013;Sachan et al 2014). Another indication is recurrent or severe pain after failure of expectant management.…”

Section: Surgery and Other Treatment Optionsmentioning

confidence: 99%