2075 A Case of Acute Abdomen Caused by Torsion of Parasitic Leiomyoma

Abstract

Study Objective The reports of parasitic leiomyoma increase with the spread of the laparoscopic surgery. The origin is considered spontaneous or iatrogenic. In iatrogenic cases, many reports mention that the cause of parasitic leiomyoma is the using morcellator for laparoscopic myomectomy or hysterectomy of leiomyoma. This condition shows various symptoms, and it may develop acute abdomen. We describe the management of this condition and discuss about parasitic leiomyoma together with a review of the literature. Design A case report. Setting A tertiary care hospital. Patients or Participants A 46-year-old, gravida 1, para 1, Japanese woman. Her past history is a laparoscopic myomectomy and excision of endometriosis in several years ago. Interventions Laparoscopic surgery. Measurements and Main Results The patient visited a practicing physician with a chief complaint of acute abdominal pain. Transabdominal ultrasound showed huge pelvic mass, and she referred to our hospital. MRI scan of the pelvic revealed a 15 cm diameter polycystic mass contained with water in the right adnexal region. Since she complained severe pain at the point of the mass, we suspected torsion of ovarian tumor, and we performed emergency laparoscopic surgery. During the procedure, we found the huge mass in the pelvis without connecting to right ovary. The mass was fed by vessels extending from the mesocolon of sigmoid colon and was twisted 1.5 rotations clockwise around the stalk. The mass was resected by the surgeon because GIST was suspected. A histopathological examination showed a leiomyoma. In immune-histological examination, c-kit was negative. Her postoperative course was uneventful. Conclusion It is important to include torsion of parasitic leiomyoma in the differential diagnosis of acute abdomen, especially, for the patients who had medical history of laparoscopic myomectomy.