A Large Parasitic Fibroid on the Mesentery

Abstract

<h3>Study Objective</h3> The objective of this video is to demonstrate a rare operative finding of a parasitic fibroid attached to the mesentery and illustrate a technique for dissection. <h3>Design</h3> Case report. <h3>Setting</h3> Robot-assisted laparoscopic removal of a parasitic fibroid on the mesentery. <h3>Patients or Participants</h3> In this video, we present a 38-year-old G1P1001 with a history of a robot-assisted myomectomy with power morcellation who presented with recurrent bulk symptoms and was found to have a large parasitic fibroid to the mesentery. <h3>Interventions</h3> Parasitic fibroids are a rare clinical phenomenon in which fibroids receive their vascular supply from somewhere other than the uterus. Though they can develop de novo, the majority are thought to be iatrogenic as a result of previous uterine surgery (Kho 2009). The FDA issued a black box warning in 2014 that discouraged use of the power morcellator due to increased risk of disseminating fibroid tissue throughout the abdomen in the setting of uncontained morcellation (US FDA 2014, Seidman 2012). Though initially abandoned due to risk of increased mortality in the setting of disseminated uterine leiomyosarcoma, the most commonly reported complication of tissue dissemination is the formation of parasitic myoma (Tulandi 2016, Seidman 2012). Incidence is described between 0.12% and 1.1% after laparoscopic uterine surgery (Lete 2016). Morcellated fragments of fibroid may be left behind in the abdominal cavity and neovascularize to surrounding structures/abdominal wall. They are often multiple and can occur in a variety of locations. <h3>Measurements and Main Results</h3> Key surgical steps for the dissection of this mass are also reviewed which include: 1. Careful abdominopelvic survey 2. Identification of feeding vessels and their origin 3. Instillation of dilute vasopressin 4. Enucleation of the fibroids 5. Assure hemostasis 6. Removal with endoscopic bag 7. Contained hand morcellation <h3>Conclusion</h3> Development of parasitic fibroids after uterine surgery is a potential source of morbidity following initial treatment.