Laparoscopic Resection of a Parasitic Leiomyoma of Mesentery Following Myomectomy.

Abstract

Objective: To illustrate the laparoscopic removal of a parasitic leiomyoma in the mesentery, which developed from a morcellation remnant following a laparoscopic myomectomy.

Setting: University hospital. A stepwise surgical demonstration with narrated video footage.

Participants: A patient with a large pelvic mass two years after undergoing laparoscopic myomectomy.

Interventions: The 31-year-old patient underwent laparoscopic myomectomy approximately two years prior, with no record of contained morcellation. Based on our inference, it is likely that a retrieval bag was not utilized during the previous fibroid morcellation. The postoperative pathology was confirmed as leiomyoma. She presented with abdominal bloating. An ultrasound at our hospital revealed an 8.2cm x 8.3cm x 7.3cm hypoechoic, irregular mass on the right side of the uterus. Pelvic magnetic resonance images (MRI) showed a mass of 6.9cm x 5.2cm x 9.7cm in the right anterior uterus with clear margins, hypointense on T2-weighted imaging, isointense on T1-weighted imaging, and significant post-contrast enhancement. Cancer antigen 125 and 199 were in normal range. Laparoscopy was performed, following these key steps: First, identifying the location of the mass and the orientation of the intestinal tract. Second, opening the pseudocapsule along the longitudinal axis of the mass. Third, gradually separating the mass from mesentery. Fourth, suturing the wound of mesentery. Finally, performing contained electromechanical morcellation. The final pathology confirmed leiomyoma.

Conclusion: The laparoscopic resection of a parasitic leiomyoma in the mesentery is feasible and safe. The critical point of the procedure is to confirm the orientation of intestinal tract and identify the anatomical space between the mass and mesentery [1]. It is possible that the use of a contained retrieval bag could have prevented the need for this surgery.