Intestinal Pseudo-Obstruction and the Menstrual Cycle: A Case Presentation

Abstract

uterus was noted to be 12 weeks size and globular. Hysteroscopy was performed, with findings of a 7 cm intracavitary mass, consistent with a leiomyoma, with a 1.5-2cm stalk arising from the fundus. It was felt that hysteroscopic removal of this mass would entail the risks of fluid overload, as well as the challenges of removal of the resected tissue. A laparotomy with trans-mural myomectomy was considered. The option of the use of the large dilators and the large grasping forceps used for 2nd trimester D&E procedures was considered. The cervix was dilated to a #59 dilator, and the grasping forceps were introduced into the uterus. To assure that the myometrium was not inadvertently grasped with the forceps, a diagnostic laparoscopy was performed concurrently. The intracavity mass was grasped with the forceps, twisted, and extracted intact through the cervix with a moderate amount of difficulty. Hysteroscopic visualization of the endometrial cavity after removal of the mass revealed minimal bleeding. Hematocrit remained stable post-operatively. Pathology revealed an 8.5 x4.5 x 3.2 cm leiomyoma weighing 9 g. Comments: This case report describes the unusual occurrence of a large intracavity uterine leiomyoma in an adolescent, causing hemorrhage and anemia, requiring transfusion. The large size and intracavity location created surgical challenges that were addressed with the use of techniques used in 2nd trimester D&E uterine evacuations.