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- Title
TORSION OF A SUBESROSAL UTERINE LEIOMYOMA A CHALLENGING DIAGNOSTIC OF ACUTE ABDOMEN PAIN: A CASE REPORT.
- Authors
Tudor, Lazar; Theodor, Stan; Rozsnyai, Francisc Florin
- Abstract
Introduction: Uterine leiomyoma its the most common benign tumor in women of reproductive age. Fibroids could have different uterine localization like subserosal, intramural and submucosal, and different dimension and symptoms are specifically those characteristics. Various complication can develop, from chronic complication like chronic pelvic pain, abnormal bleeding, dysmenorrhea, infertility to acute complication like torsion or acute degenerative fibroid. Torsion is specifically to subserosal pediculate fibroids and is a rare acute complication which cause acute abdominal pain that require immediately surgical treatment. This acute complication of fibroids is often difficult to diagnose preoperatory and misdiagnosed or prolonged time till intervention could lead to severe comorbidities. Case Report: A 38-year-old women without medical history of uterine fibroid is presenting to emergency department with acute lower abdominal pain. Laboratory data showed WBC: 10.62 103 /µL, Neutrophils 8.68 103/µL, Hb ... negative pregnancy test. Due to persistent abdominal pain a CT scan was performed. A nodular image projected on left ovarian fossa with 23/28mm dimension was described and another image nearby without differentiation from the other with 68/70 mm dimension with fluidal characteristics. Right ovary and the uterus were normal described, without others particularities. An exploratory diagnostic laparoscopy was performed and a huge subserosal pediculate uterine fibroma 360 degree torsion was discover. Due to dimension of fibroid (cca.10 x 6 cm) and the torsion a conversion to laparotomy was conducted. A successful myomectomy was performed and patient was discharged 3 days later without complications. Discussions : Acute abdominal pain caused by leiomyomas is rarely occurred and others pelvic pathologies should be considerate and because of that its a challenging diagnose. In our patient the CT performed was unable to identify the leiomyoma, but helped to lead to the affected organ, also useful to exclude other possible causes of abdominal pain. Magnetic resonance imaging (MRI) is the most effective modality for visualizing the size and location of the uterine fibroma. Conclusions: Despite of paraclinical investigation computerized tomography (CT) the acute abdominal pain still remain one of the most challenging diagnoses among patients who present to the emergency department (ED). Delayed treatment of uterine leiomyoma torsion could led to severe morbidity. Once the diagnose is suspected, the gynecologist must be consulted and surgical intervention should be immediately required.
- Subjects
ROMANIA; MYOMETRIUM surgery; UTERINE tumors; TORSION abnormality (Anatomy); LAPAROSCOPY; MYOMETRIUM; ABDOMINAL pain; ABDOMINAL surgery; CONFERENCES &; conventions; UTERINE fibroids
- Publication
Acta Marisiensis. Seria Medica, 2024, Vol 70, p326
- ISSN
2668-7755
- Publication type
Article