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Abstract
We report a case of 39 years old South Indian lady, with recurrent pain abdomen and mass per abdomen for two years. Due to COVID pandemic, this patient was on symptomatic medical management with pending surgical treatment. Though all the conventional diagnostic modalities were done, the exact diagnosis was comprehended only at laparoscopy. This report describes an iatrogenic induced parasitic fibroid from a previous surgery, which was successfully managed by laparoscopic myomectomy with a ‘contained morcellation technique’.
The gold standard surgical management for fibroids is laparoscopy myomectomy, which is fertility sparing surgery. Laparoscopic myomectomy is a relatively safe procedure. But the drawback is the inability to remove the myoma en masse. Morcellation was thus devised to overcome this challenge. Nonetheless, the issue of inadvertent scattering of the tissues may occur during morcellation which can disseminate endometriosis, sarcoma & could root parasitic fibroids. These disadvantages can be overcome by the practice of using ‘in bag morcellation’, to mitigate suspicious pathology from being disseminated. Nevertheless, this procedure can increase the operating time.
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References
- Paul PG, Shintre H, Mehta S, et al. Parasitic myomas: an unusual risk after morcellation. Gynecology & Minimal Invasive Therapy 2018;7(3):124-6.
- Varun N, Elahi AA, Nigam A, et al. Parasitic fibroid during pregnancy: a diagnostic dilemma (rare case report). Indian J Obstet Gynecol Res 2017:4(4):458-9.
- Hafizi L, Pourhoseini SA. Abdominal wall leiomyoma: a case report. J Reprod Infertil 2020;21(2):151-4.
- Ladke AB, Palaskar PA, Bhivsane VR. Parasitic fibroid: complication of post laparoscopic morcellation. J Obstet Gynaecol India 2021;71(2):207-9.
- Lete I, González J, Ugarte L, et al. Parasitic leiomyomas: a systematic review. Eur J Obstet Gynecol Reprod Biol 2016;203:250-9.
- Kale T, Tambe S, Alnur Y. Parasitic fibroid: a diagnostic dilemma. The New Indian Journal of OBGYN 2016;3(1):47-50.
- Lu B, Xu J, Pan Z. Iatrogenic parasitic leiomyoma and leiomyomatosis peritonealis disseminata following uterine Morcellation. J Obstet Gynaecol Res 2016;42(8):990-9.
- Goyal N, Khurana N. Leiomyoma of rectus sheath: an uncommon entity: report of two cases. Indian J Pathol Microbiol 2010;53(3):591-2.
- Mousa HM, Al-Salam SA, Alia Abdullah A, et al. Primary anterior abdominal wall leiomyoma in a pregnant woman. ANZ J Surg 2019;89(11):E527-8.
- Chittawar PB, Franik S, Pouwer AW, et al. Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database Syst Rev 2014(10):CD004638.
- Pereira N, Buchanan TR, Wishall KM, et al. Electric morcellation-related reoperations after laparoscopic myomectomy and nonmyomectomy procedures. J Minim Invasive Gynecol 2015;22(2):163-76.
- Zullo F, Venturella R, Raffone A, et al. In-bag manual versus uncontained power morcellation for laparoscopic myomectomy. Cochrane Database Syst Rev 2020;5(5):CD013352.
- Cohen A, Tulandi T. Long-term sequelae of unconfined morcellation during laparoscopic gynecological surgery. Maturitas 2017;97:1-5.
- Tulandi T, Leung A, Jan N. Nonmalignant sequelae of unconfined morcellation at laparoscopic hysterectomy or myomectomy. J Minim Invasive Gynecol 2016;23(3):331-7.
References
Paul PG, Shintre H, Mehta S, et al. Parasitic myomas: an unusual risk after morcellation. Gynecology & Minimal Invasive Therapy 2018;7(3):124-6.
Varun N, Elahi AA, Nigam A, et al. Parasitic fibroid during pregnancy: a diagnostic dilemma (rare case report). Indian J Obstet Gynecol Res 2017:4(4):458-9.
Hafizi L, Pourhoseini SA. Abdominal wall leiomyoma: a case report. J Reprod Infertil 2020;21(2):151-4.
Ladke AB, Palaskar PA, Bhivsane VR. Parasitic fibroid: complication of post laparoscopic morcellation. J Obstet Gynaecol India 2021;71(2):207-9.
Lete I, González J, Ugarte L, et al. Parasitic leiomyomas: a systematic review. Eur J Obstet Gynecol Reprod Biol 2016;203:250-9.
Kale T, Tambe S, Alnur Y. Parasitic fibroid: a diagnostic dilemma. The New Indian Journal of OBGYN 2016;3(1):47-50.
Lu B, Xu J, Pan Z. Iatrogenic parasitic leiomyoma and leiomyomatosis peritonealis disseminata following uterine Morcellation. J Obstet Gynaecol Res 2016;42(8):990-9.
Goyal N, Khurana N. Leiomyoma of rectus sheath: an uncommon entity: report of two cases. Indian J Pathol Microbiol 2010;53(3):591-2.
Mousa HM, Al-Salam SA, Alia Abdullah A, et al. Primary anterior abdominal wall leiomyoma in a pregnant woman. ANZ J Surg 2019;89(11):E527-8.
Chittawar PB, Franik S, Pouwer AW, et al. Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database Syst Rev 2014(10):CD004638.
Pereira N, Buchanan TR, Wishall KM, et al. Electric morcellation-related reoperations after laparoscopic myomectomy and nonmyomectomy procedures. J Minim Invasive Gynecol 2015;22(2):163-76.
Zullo F, Venturella R, Raffone A, et al. In-bag manual versus uncontained power morcellation for laparoscopic myomectomy. Cochrane Database Syst Rev 2020;5(5):CD013352.
Cohen A, Tulandi T. Long-term sequelae of unconfined morcellation during laparoscopic gynecological surgery. Maturitas 2017;97:1-5.
Tulandi T, Leung A, Jan N. Nonmalignant sequelae of unconfined morcellation at laparoscopic hysterectomy or myomectomy. J Minim Invasive Gynecol 2016;23(3):331-7.