Spontaneous Rupture of Leiomyoma Diagnosed Preoperatively with Noncontrast Computed Tomography

Shan, Angel; Harjee, Rahana; McLaughlin, Patrick D.; Jones, Edward C.

doi:10.1155/2020/5364165

Cited by 2 publications

(1 citation statement)

References 9 publications

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“…[32,33] Contrasted CT and magnetic resonance imaging (MRI) are considered as further examinations and they are highly accurate for differentiating benign from malignant, especially for the patients who have a large body mass index or had prior surgery. [34][35][36] Pathological findings remain the "gold standard" for making a definite diagnosis. However, a diagnostic puncture may increase the risks of needle tract tumor cell seedings if the neoplasm is malignant in some cases.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted tumorectomy for an unusual pelvic retroperitoneal leiomyoma: A case report

2022

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Rationale: Extrauterine leiomyoma occasionally occurs in rare locations with unusual growth patterns, especially pelvic retroperitoneal leiomyoma, which brings great challenges for surgeons to make a diagnosis. It is essential to distinguish benign from malignant retroperitoneal neoplasms according to the imaging manifestations. Laparotomy and laparoscopy are the common options for pelvic retroperitoneal neoplasms, while they may cause side effects during operation such as secondary damage. Appropriate surgical techniques should be adopted to ensure the complete excision of neoplasms meanwhile preserve the urination, defecation, and sexual function.Patient concerns: A 30-year-old woman was referred to our hospital because of dull pain in the perianal region for 1 month. Laboratory results including tumor markers were all within normal limits. The digital rectal examination revealed a huge and tough mass with smooth mucosa protruding into the rectal cavity from the rear area of rectum.Diagnosis: Imaging examinations were performed. Contrasted computed tomography (CT) of pelvis showed an enhanced retroperitoneal solid mass in the space between sacrum and rectum, and very close to the levator ani muscle. The mass was about 11.0*8.0 cm in size. Computerized tomography angiography (CTA) showed the distal branches of bilateral internal iliac artery went into the mass. Endoscopic ultrasonography (US) showed the mass compressed the rectum, as well as a clear boundary to the rectal wall. A histopathologic examination confirmed the mass was a pelvic retroperitoneal leiomyoma. Interventions:The patient underwent an operative resection with da Vinci Si surgical system after routine preoperative preparation. Anorectal motility was weekly monitored postoperation. No additional adjuvant therapy was performed.Outcomes: The patient could walk after 1 day and defecate normally on the third day after operation. She was discharged on the seventh postoperative day. No adverse events including pelvic floor hernia or defecation dysfunction occurred in the follow-up period. At 4 weeks follow-up, the patient was pain-free and recovered well.Lessons: Although imaging examinations were crucial for retroperitoneal neoplasms, histopathological examination remains the "gold standard" for making a definite diagnosis. This case highlights the possibility of retroperitoneal leiomyoma occurring in a woman of reproductive age and the advantages of robotic surgical system in pelvic retroperitoneal surgeries.Abbreviations: CD = cluster of differentiation, CT = computed tomography, CTA = computerized tomography angiography, ER = estrogen receptor, MRI = magnetic resonance imaging, PR = progesterone receptor, US = ultrasonography.

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Section: Discussionmentioning

confidence: 99%

Robot-assisted tumorectomy for an unusual pelvic retroperitoneal leiomyoma: A case report

2022

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Painless spontaneous haemoperitoneum secondary to a uterine leiomyoma/fibroid: unusual presentation of a life-threatening differential

et al. 2021

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This is a case of a 47-year-old woman with a spontaneous haemoperitoneum secondary to uterine leiomyomas (fibroids), an important differential diagnosis in patients with uterine fibroids and hypovolaemic shock. Uterine fibroids are very common in women of reproductive age, yet little is taught about their potential to cause hypovolaemic shock. Although it is a rare complication, given the prevalence of fibroids, it is important to bear this life-threatening differential in mind to optimise the care for these women. Presentation typically involves abdominal pain, syncope, haemodynamic instability and an intra-abdominal mass. CT of the abdomen and pelvis can be helpful in identifying the source of the haemoperitoneum, but should not delay surgery, which is the definitive management.

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Spontaneous Rupture of Leiomyoma Diagnosed Preoperatively with Noncontrast Computed Tomography

Cited by 2 publications

References 9 publications

Robot-assisted tumorectomy for an unusual pelvic retroperitoneal leiomyoma: A case report

Robot-assisted tumorectomy for an unusual pelvic retroperitoneal leiomyoma: A case report

Painless spontaneous haemoperitoneum secondary to a uterine leiomyoma/fibroid: unusual presentation of a life-threatening differential

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