Disseminated Peritoneal Leiomyomatosis of the Peritoneum Following Laparoscopic Supracervical Hysterectomy with Morcellation: A Case Report.

Abstract

BACKGROUND Disseminated peritoneal leiomyomatosis is a rare complication of laparoscopic procedures involving uterine morcellation. These fibroid-like lesions, which derive their blood supply from non-uterine sources, may develop after myomectomy, supracervical hysterectomy, or total laparoscopic hysterectomy - particularly when mechanical morcellation is used. Although the incidence is low, disseminated leiomyomatosis should be considered in the differential diagnosis of abdominal or pelvic pain in patients with a history of such surgeries. CASE REPORT A 40-year-old woman presented with intermittent lower abdominal pain. She had undergone a laparoscopic supracervical hysterectomy with salpingectomy 5 years earlier due to abnormal uterine bleeding, during which uncontained mechanical morcellation was performed. At present, transvaginal ultrasound revealed a solid mass adjacent to the bladder with features suggestive of a leiomyoma. Magnetic resonance imaging (MRI) showed multiple lesions, including a polycyclic mass located above the bladder and additional foci near the sigmoid colon and the bladder dome. Laparoscopy confirmed the presence of leiomyomas on the anterior abdominal wall, sigmoid colon adventitia, and bladder dome. All lesions were excised using laparoscopic techniques, and the postoperative course was uneventful. Histopathological examination confirmed leiomyomas with positive estrogen and progesterone receptor expression. CONCLUSIONS This case underscores the importance of considering disseminated peritoneal leiomyomatosis in the differential diagnosis of abdominal or pelvic pain in patients with a history of laparoscopic hysterectomy with morcellation. It also emphasizes that this condition can mimic malignancy on imaging studies and highlights the essential role of histopathological examination in diagnosing this benign disease.