Torsion of a Subserosal Myoma Managed by Gasless Laparoendoscopic Single-Site Myomectomy with In-Bag Manual Extraction.

Akihiro Takeda,Hiromi Nakamura

doi:10.1155/2016/7831270

Abstract

Acute torsion of a subserosal myoma is a rare surgical emergency that is infrequently diagnosed preoperatively. Furthermore, laparoendoscopic single-site (LESS) myomectomy with in-bag tissue extraction for the management of this disorder has not yet been described. A 43-year-old, gravida 1, para 1 woman was referred to our department due to a solid pelvic mass associated with persistent abdominal pain. A pedunculated subserosal myoma with torsion was strongly suspected based on ultrasonography and magnetic resonance imaging. Emergency LESS surgery showed that the subserosal myoma arising from the posterior uterine wall torted at its pedicle in the cul-de-sac. The twisted myoma node was excised by coagulation and cut using a LigaSure Atlas, followed by in-bag manual morcellation and extraction through an umbilical wound. The present case report emphasizes that LESS myomectomy with in-bag tissue extraction is a feasible minimally invasive surgical option for the management of subserosal myoma with torsion after a precise imaging-based diagnostic evaluation.

Highlights

IntroductionThe symptoms of a uterine myoma include menorrhagia, abnormal bleeding, dysmenorrhea, dyspareunia, pelvic pain, and frequent urination [1]
Uterine myoma is the most common benign neoplasm in women of reproductive age [1]
While surgical exploration of the twisted myoma usually resolves the problem, the challenge is in making the appropriate diagnosis, which is difficult because of the limited known imaging-based diagnostic characteristics [3, 5, 8]

Summary

Introduction

The symptoms of a uterine myoma include menorrhagia, abnormal bleeding, dysmenorrhea, dyspareunia, pelvic pain, and frequent urination [1]. Most of these symptoms occur as chronic manifestations, myoma can cause acute complications in rare cases [1, 2]. We report a rare case of torsion of a subserosal myoma that was successfully managed by emergency LESS myomectomy with transumbilical in-bag manual morcellation and extraction, after a diagnosis was made based on ultrasonography and magnetic resonance imaging (MRI). Institutional review board approval from Gifu Prefectural Tajimi Hospital was obtained to report this case

Case Report

Discussion

Conclusion