Disseminated peritoneal leiomyomatosis presenting as port site hernial sac contents following laparoscopic myomectomy

Abstract

Disseminated Peritoneal Leiomyomatosis (DPL) is a rare, benign condition characterized by the proliferation of multiple smooth muscle-like nodules on the peritoneal surfaces. It is strongly associated with iatrogenic seeding following uterine surgeries, particularly laparoscopic myomectomy with power morcellation. We report the case of a 37-year-old, para 2, live 2 (P2L2) females with a history of laparoscopic myomectomy 4 years back. She presented with an 8-month history of dull abdominal pain and a progressive abdominal swelling. Clinical examination and imaging revealed a large 5x5 cm left port site incisional hernia and fibroid uterus of 10 weeks size. Both magnetic resonance imaging (MRI) and contrast-enhanced computed tomography (CECT) confirmed the hernia, and surprisingly, identified multiple nodular, enhancing lesions within the hernia sac, as well as in the left iliac fossa, consistent with peritoneal fibroids. The patient underwent an elective exploratory laparotomy, which confirmed the findings. The hernia sac contained multiple firm nodules consistent with fibromatosis. A total abdominal hysterectomy, bilateral salpingectomy, and excision of all visible peritoneal lesions was performed, followed by an incisional hernia repair with onlay mesh. The intraoperative findings and histopathology were consistent with DPL. This case highlights an unusual presentation of DPL where the lesions were found as the primary contents of an incisional hernia. DPL should be considered in the differential diagnosis for new peritoneal masses or unusual hernia contents in female patients with a history of uterine surgery.