Surgical challenges in unusual fibroids - a case series
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20222483Keywords:
Cervical fibroid, Broad lig fibroid, Huge fibroid, Fibroid polyp, Ureter injuryAbstract
Uterine leiomyoma are benign monoclonal tumours arising from smooth muscle tissue. There are different types of fibroids depending on the location of fibroid. There are various operative challenges in long standing huge fibroids on abnormal location. Surgical difficulties associated with these cases are due to poor access to the operative field, distorted anatomy, difficulty in suturing the repairs, increased blood loss. It is an art and skill to surgically remove these difficult fibroids and do difficult hysterectomies. Here we present case series of 7 cases, we have described variety of fibroid at different ages, presentations, precautions and also surgical challenges and the steps to overcome them successfully. Case 1- cervical fibroid, case 2- submucosal fibroid polyp, case 3- Bulky uterus with fundal fibroid during vaginal hysterectomy, case 4- broad ligament fibroid, case 5- multiple fibroids, case 6- multiple subserosal fibroids during caesarean section, and case 7- giant fibroid. Different types of fibroids are tackled in different ways. So, fibroid mapping by imaging studies and also ureteric stenting preoperatively whenever needed, helps to prevent untoward injuries. Following principles of surgery in any difficult fibroids leads to successful management and also helps to prevent injuries to the urinary tract and avoiding intra operative blood loss.
References
De La Cruz MS, Buchanan EM. Uterine Fibroids: Diagnosis and Treatment. Am Fam Physician. 2017;95(2):100-7.
Stewart EA, Laughlin-Tommaso SK, Catherino WH, Lalitkumar S, Gupta D, Vollenhoven B. Uterine fibroids. Nat Rev. 2016;2:1-18.
Khan AT, Shehmar M, Gupta JK. Uterine fibroids: current perspectives. Int J Womens Health. 2014;6:95-114.
Brunsell S. Uterine Fibroid Tumors: Diagnosis and Treatment. Am Fam Physician. 2007;75(10):1503-8.
Donnez J, Marie-Madeleine Dolmans M-M. Uterine fibroid management: from the present to the future. Hum Reprod Update. 2016;22(6):665-86.
Vilos GA, Allaire C, Laberge PY, Leyland N. The management of uterine leiomyomas. SOGC Clinical Practice Guideline. J Obstet Gynaecol Can. 2015;37(2):157-78.
Bhatla N. Tumours of the corpus uteri. In: Jeffcoates Principles of Gynaecology. 5th edition. London: Arnold Publisher. 2001;470.
Buttram VC Jr, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril. 1981;36:433.
Singh S, Chaudhary P. Central cervical fibroid mimicking as chronic uterine inversion, Int J Reprod Contracept Obstet Gynaecol. 2013;2(4):687-8.
Rajshree K, Nisha T, Soni M, Sivanandini A. Cervical Fibroids with Its Management and Review of Literature: An Original Article. SEAJCRR. 2017;6(1):5-9.
Monaghan JM, Lopes AB, Naik R. Total hysterectomy for cervical and broad ligament fibroids. In: Huxley R, Taylor S, Chandler K, eds. Bonney’s Gynaecological Surgery. 10th edition. Maiden, USA: Blackwell Publishing Company. 2004;74-86.
Matytsina-Quinlan L, Matytsina L. Submucosal uterine fibroid prolapsed into vagina in a symptomatic patient with IUS. BMJ Case Rep. 2014;bcr2014203877.
Hui D, Yi Z, Bo L. Clinical observation method [J] Great remove the uterus transvaginal hysterectomy modified. Chinese Med J. 2013;93(41):3284-7.
Rameshkumar R, Naik SN, Dhanalakshmi. Non-descent vaginal hysterectomy for large uterus - safety and feasibility. Int J Reprod Contracept Obstet Gynecol. 2018;7:3563-7.
Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BW, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015;(8):CD003677.
El-Agwany AS. Huge broad ligament fibroid with paracervical extension: A safe approach by same setting myomectomy before hysterectomy. J Med Ultrasound. 2018;26:45-7.
Kindinger LM, Setchell TE, Miskry TS. Broad ligament fibroids—a radiological and surgical challenge, Gynecol Surg. 2014;11:19-22.
Makde S, More V, Gawai S, Choudhari D, Nayak A. Broad ligament fibroid in treated breast carcinoma patient. Int J Reprod Contracept Obstet Gynecol. 2022;11:2027-30.
Panayotidis C, Salleh S, Martin JE, Hirsh P, Wynn J. Giant uterine leiomyomas: dilemmas in surgical management, Gynecol Surg. 2006;3:37-40.
Lethaby A, Vollenhoven B, Sowter M. Efficacy of preoperative gonadotrophin hormone releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy: a systematic review. Br J Obstet Gynaecol. 2002;109(10):1097-108.
Vercellini P, Crosignani PG, Mangioni C, Imparato E, Ferrari A, De Giorgi O. Treatment with a gonadotrophin releasing hormone agonist before hysterectomy for leiomyomas: results of a multicentre, randomised controlled trial. Br J Obstet Gynaecol. 1998;105(11):1148-54.
Garg P, Bansal R. Cesarean myomectomy: a case report and review of the literature. J Med Case Rep. 2021;15:193.
Guler AE, Guler ZÇD, Kinci MF, Mungan MT. Myomectomy during cesarean section: why do we abstain from? J Obstet Gynecol India. 2020;70(2):133-7.
Kwawukume E. Myomectomy during cesarean section. Int J Gynecol Obstet. 2002;76(2):183-4.
Kaymak O, Ustunyurt E, Okyay RE, Kalyoncu S, Mollamahmutoglu L. Myomectomy during cesarean section. Int J Gynecol Obstet. 2005;89(2):90-3.
