Surgical Treatment of Multiple Parasitic Leiomyomas 14 Years after Laparoscopic Myomectomy Utilizing Power Morcellation

Abstract

Study Objective To describe a unique case-presentation and demonstrate the surgical technique used for complete excision of multiple parasitic leiomyomas 14 years after history of power morcellation. Design Video of case-presentation Setting Academic hospital Patients or Participants Single surgical patient Interventions Surgical technique used for removal of multiple parasitic leiomyomas Measurements and Main Results A 43-year-old woman presented with a symptomatic enlarged fibroid uterus, abnormal uterine bleeding, and pelvic pain 14 years after laparoscopic myomectomy using power morcellation. Diagnostic imaging revealed pelvic masses most consistent with multiple uterine fibroids with predominant large posterior pedunculated fibroid. She was scheduled for total laparoscopic hysterectomy and bilateral salpingectomy. Intraoperatively, she was found to have multiple parasitic leiomyomas throughout the abdomen and pelvis which included the abdominal wall, small bowel mesentery, and colon. Complete laparoscopic excision of all leiomyomas was performed without complication. Histopathology confirmed diagnosis of benign leiomyomata uteri. Conclusion Parasitic leiomyomas are a rare, late sequelae of laparoscopic myomectomy with power morcellation. Initial diagnostic imaging may be misleading; therefore, surgical excision is warranted for diagnosis and treatment. Laparoscopic excision of multiple parasitic myomas can be performed safely and is considered definitive treatment. To describe a unique case-presentation and demonstrate the surgical technique used for complete excision of multiple parasitic leiomyomas 14 years after history of power morcellation. Video of case-presentation Academic hospital Single surgical patient Surgical technique used for removal of multiple parasitic leiomyomas A 43-year-old woman presented with a symptomatic enlarged fibroid uterus, abnormal uterine bleeding, and pelvic pain 14 years after laparoscopic myomectomy using power morcellation. Diagnostic imaging revealed pelvic masses most consistent with multiple uterine fibroids with predominant large posterior pedunculated fibroid. She was scheduled for total laparoscopic hysterectomy and bilateral salpingectomy. Intraoperatively, she was found to have multiple parasitic leiomyomas throughout the abdomen and pelvis which included the abdominal wall, small bowel mesentery, and colon. Complete laparoscopic excision of all leiomyomas was performed without complication. Histopathology confirmed diagnosis of benign leiomyomata uteri. Parasitic leiomyomas are a rare, late sequelae of laparoscopic myomectomy with power morcellation. Initial diagnostic imaging may be misleading; therefore, surgical excision is warranted for diagnosis and treatment. Laparoscopic excision of multiple parasitic myomas can be performed safely and is considered definitive treatment.