Multiple morcelloma of the abdominal cavity: a case report

Introduction. Uterine fibroids are benign monoclonal hormone-sensitive tumors arising from smooth muscle cells of the cervix or body uterus. Myomectomy has become a treatment «golden standard» upon transition to the strategy of organ-preserving surgery. The introduction of morcellation into wide clinical practice allowed to expand the indications for laparoscopic myomectomy, which is usually much better tolerated by patients due to lower invasiveness, short period of rehabilitation and low blood loss. However, the use of morcellators along with the obvious advantages has also specific complications particularly emergence of iatrogenic parasitic fibroids of the abdominal cavity upon improper surgery technique.

Aim: analysis of a clinical case of multiple morcelloma.

Case presentation. Female patient I., 57 years old, underwent laparoscopic myomectomy in 2003. In 2023 during a routine examination at the Central Clinical Hospital «RZD-Medicine» multiple asymptomatic iatrogenic fibroids of the abdominal cavity were revealed. The patient underwent planned surgical intervention to remove all abnormal masses.

Results. During the revision upon surgical intervention, a node of 1.5x1.5 cm was found on the parietal peritoneum along the left anterior wall, as well as a node of 1.5x1.5 cm on the parietal peritoneum along the right anterior wall. There was also observed a 2x3 cm node at the edge of the omentum. In the left and right side of peritoneum of the sacro-uterine ligament, there were found nodes of up to 1.0 cm in size. In the area of the small intestinal mesentery, a dense node of 4.5 cm was observed 70 cm away from the ileocecal valve. Due to small size, all the fibroids were extirpated and removed from the abdominal cavity without morcellation, complete hemostasis was performed. No complications were noted during postoperative period.

Conclusion. Iatrogenic fibroids are quite rare but nevertheless a potential complication of laparoscopic myomectomy. Gynecologists should pay special attention to follow proper technique upon surgical intervention. Morcellation and subsequent extraction of fibroids should be performed strictly with use of airtight container to avoid ingress of myomatous tissue into the abdominal cavity followed by emergence of iatrogenic fibroids.

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