Giant uterine fibroid with phlegmona of the anterior abdominal wall

Abstract

This report presents a rare case of giant uterine fibroids in a 52-year-old patient, which was complicated by phlegmon of the anterior abdominal wall. Physical examination revealed skin necrosis above the navel, measuring 12×10 cm, with purulent content. On palpation, a space-occupying formation reaching the xiphoid process was noted, indicating an abdominal distension. The patient underwent surgery as planned; a suppurated section of the anterior abdominal wall, extending to the aponeurosis, was placed on the operating table. An inferomedial laparotomy with excision of a necrotic, suppurating area of the anterior abdominal wall was performed. Furthermore, a mass in the abdominal cavity was removed using a blunt and sharp method, and extirpation of the uterus and appendages was conducted. Histological examination revealed a giant uterine leiomyoma with stromal hyalinosis and omentitis. The patient was discharged on postoperative day 10 in satisfactory condition. No complications were observed during the postoperative period. Advanced uterine fibroids are common, and ignoring the need to undergo regular medical examinations and insufficient medical examination coverage can lead to such complications, which can significantly affect the quality of life of patients.

Keywords

leiomyoma / uterine neoplasms / fibroid uterus / cellulitis / case report

References

[1] Parker WH. Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril. 2007;87(4):725–736. doi: 10.1016/j.fertnstert.2007.01.093

[2] Parker W.H. Etiology, symptomatology, and diagnosis of uterine myomas // Fertil Steril. 2007. Vol. 87, N 4. P. 725–736. doi: 10.1016/j.fertnstert.2007.01.093

[3] Parker WH. Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril. 2007;87(4):725–736. doi: 10.1016/j.fertnstert.2007.01.093

[4] Babunashvili EL, Shchukina NA, Buyanova SN, et al. Possibilities of rehabilitation of patients of reproductive age after myomectomy. Russian Bulletin of Obstetrician-Gynecologist. 2022;22(3):93–99. EDN: EGUGSS doi: 10.17116/rosakush20222203193

[5] Бабунашвили Е.Л., Щукина Н.А., Буянова С.Н., и др. Возможности реабилитации пациенток репродуктивного возраста после миомэктомии // Российский вестник акушера-гинеколога. 2022. Т. 22, № 3. С. 93–99. EDN: EGUGSS doi: 10.17116/rosakush20222203193

[6] Babunashvili EL, Shchukina NA, Buyanova SN, et al. Possibilities of rehabilitation of patients of reproductive age after myomectomy. Russian Bulletin of Obstetrician-Gynecologist. 2022;22(3):93–99. EDN: EGUGSS doi: 10.17116/rosakush20222203193

[7] Tan N, McClure TD, Tarnay C, et al. Women seeking second opinion for symptomatic uterine leiomyoma: role of comprehensive fibroid center. J Ther Ultrasound. 2014;2:3. doi: 10.1186/2050-5736-2-3

[8] Tan N., McClure T.D., Tarnay C., et al. Women seeking second opinion for symptomatic uterine leiomyoma: role of comprehensive fibroid center // J Ther Ultrasound. 2014. Vol. 2. P. 3. doi: 10.1186/2050-5736-2-3

[9] Tan N, McClure TD, Tarnay C, et al. Women seeking second opinion for symptomatic uterine leiomyoma: role of comprehensive fibroid center. J Ther Ultrasound. 2014;2:3. doi: 10.1186/2050-5736-2-3

[10] Knight J, Falcone T. Tissue extraction by morcellation: a clinical dilemma. J Minim Invasive Gynecol. 2014;21(3):319–320. doi: 10.1016/j.jmig.2014.03.005

[11] Knight J., Falcone T. Tissue extraction by morcellation: a clinical dilemma // J Minim Invasive Gynecol. 2014. Vol. 21, N 3. P. 319–320. doi: 10.1016/j.jmig.2014.03.005

[12] Knight J, Falcone T. Tissue extraction by morcellation: a clinical dilemma. J Minim Invasive Gynecol. 2014;21(3):319–320. doi: 10.1016/j.jmig.2014.03.005

[13] Schoolmeester JK, Erickson LA. Uterine Leiomyoma. Mayo Clin Proc. 2019;94(10):2150–2151. doi: 10.1016/j.mayocp.2019.08.019

[14] Schoolmeester J.K., Erickson L.A. Uterine Leiomyoma // Mayo Clin Proc. 2019. Vol. 94, N 10. P. 2150–2151. doi: 10.1016/j.mayocp.2019.08.019

[15] Schoolmeester JK, Erickson LA. Uterine Leiomyoma. Mayo Clin Proc. 2019;94(10):2150–2151. doi: 10.1016/j.mayocp.2019.08.019

[16] Lewis TD, Malik M, Britten J, et al. A comprehensive review of the pharmacologic management of uterine leiomyoma. Biomed Res Int. 2018;2018:2414609. doi: 10.1155/2018/2414609

[17] Lewis T.D., Malik M., Britten J., et al. A comprehensive review of the pharmacologic management of uterine leiomyoma // Biomed Res Int. 2018. Vol. 2018. P. 2414609. doi: 10.1155/2018/2414609

[18] Lewis TD, Malik M, Britten J, et al. A comprehensive review of the pharmacologic management of uterine leiomyoma. Biomed Res Int. 2018;2018:2414609. doi: 10.1155/2018/2414609

[19] Stewart EA, Lukes AS, Venturella R, et al. Relugolix combination therapy for uterine leiomyoma-associated pain in the LIBERTY randomized trials. Obstet Gynecol. 2022;139(6):1070–1081. doi: 10.1097/AOG.0000000000004787

[20] Stewart E.A., Lukes A.S., Venturella R., et al. Relugolix combination therapy for uterine leiomyoma-associated pain in the LIBERTY randomized trials // Obstet Gynecol. 2022. Vol. 139, N 6. P. 1070–1081. doi: 10.1097/AOG.0000000000004787

[21] Stewart EA, Lukes AS, Venturella R, et al. Relugolix combination therapy for uterine leiomyoma-associated pain in the LIBERTY randomized trials. Obstet Gynecol. 2022;139(6):1070–1081. doi: 10.1097/AOG.0000000000004787

[22] Pulgar VM. Uterine leiomyoma and hypertensive disorders in pregnancy. J Hypertens. 2021;39(5):869–870. doi: 10.1097/HJH.0000000000002777

[23] Pulgar V.M. Uterine leiomyoma and hypertensive disorders in pregnancy // J Hypertens. 2021. Vol. 39, N 5. P. 869–870. doi: 10.1097/HJH.0000000000002777

[24] Pulgar VM. Uterine leiomyoma and hypertensive disorders in pregnancy. J Hypertens. 2021;39(5):869–870. doi: 10.1097/HJH.0000000000002777

[25] Jenabi E, Khazaei S. The effect of uterine leiomyoma on the risk of malpresentation and cesarean: a meta-analysis. J Matern Fetal Neonatal Med. 2018;31(1):87–92. doi: 10.1080/14767058.2016.1275553

[26] Jenabi E., Khazaei S. The effect of uterine leiomyoma on the risk of malpresentation and cesarean: a meta-analysis // J Matern Fetal Neonatal Med. 2018. Vol. 31, N 1. P. 87–92. doi: 10.1080/14767058.2016.1275553

[27] Jenabi E, Khazaei S. The effect of uterine leiomyoma on the risk of malpresentation and cesarean: a meta-analysis. J Matern Fetal Neonatal Med. 2018;31(1):87–92. doi: 10.1080/14767058.2016.1275553

[28] Dagur G, Suh Y, Warren K, et al. Urological complications of uterine leiomyoma: a review of literature. Int Urol Nephrol. 2016;48(6):941–948. doi: 10.1007/s11255-016-1248-5

[29] Dagur G., Suh Y., Warren K., et al. Urological complications of uterine leiomyoma: a review of literature // Int Urol Nephrol. 2016. Vol. 48, N 6. P. 941–948. doi: 10.1007/s11255-016-1248-5

[30] Dagur G, Suh Y, Warren K, et al. Urological complications of uterine leiomyoma: a review of literature. Int Urol Nephrol. 2016;48(6):941–948. doi: 10.1007/s11255-016-1248-5

[31] Vilos GA, Allaire C, Laberge PY, Leyland N. The management of uterine leiomyomas. J Obstet Gynaecol Can. 2015;37(2):157–178. doi: 10.1016/S1701-2163(15)30338-8

[32] Vilos G.A., Allaire C., Laberge P.Y., Leyland N. The management of uterine leiomyomas // J Obstet Gynaecol Can. 2015. Vol. 37, N 2. P. 157–178. doi: 10.1016/S1701-2163(15)30338-8

[33] Vilos GA, Allaire C, Laberge PY, Leyland N. The management of uterine leiomyomas. J Obstet Gynaecol Can. 2015;37(2):157–178. doi: 10.1016/S1701-2163(15)30338-8

[34] Agarwal SK, Stokes M, Kung T, et al. Describing the patient journey of women with claims for uterine fibroids and heavy menstrual bleeding using a commercial database (2011–2020). Int J Womens Health. 2023;15:1561–1575. doi: 10.2147/IJWH.S420612

[35] Agarwal S.K., Stokes M., Kung T., et al. Describing the patient journey of women with claims for uterine fibroids and heavy menstrual bleeding using a commercial database (2011–2020) // Int J Womens Health. 2023. Vol. 15. P. 1561–1575. doi: 10.2147/IJWH.S420612

[36] Agarwal SK, Stokes M, Kung T, et al. Describing the patient journey of women with claims for uterine fibroids and heavy menstrual bleeding using a commercial database (2011–2020). Int J Womens Health. 2023;15:1561–1575. doi: 10.2147/IJWH.S420612

[37] Ishchenko AI, Myshenkova SA, Zhumanova EN, et al. Uterine artery embolization: efficiency in women with unrealized reproductive function. V.F. Snegirev Archives of Obstetrics and Gynecology. 2015;2(1):26–30. EDN: TQKFOP doi: 10.17816/aog35266

[38] Ищенко А.И., Мышенкова С.А., Жуманова Е.Н., и др. Эмболизация маточных артерий: целесообразность применения у женщин с нереализованной репродуктивной функцией // Архив акушерства и гинекологии им. В.Ф. Снегирёва. 2015. Т. 2, № 1. С. 26–30. EDN: TQKFOP doi: 10.17816/aog35266

[39] Ishchenko AI, Myshenkova SA, Zhumanova EN, et al. Uterine artery embolization: efficiency in women with unrealized reproductive function. V.F. Snegirev Archives of Obstetrics and Gynecology. 2015;2(1):26–30. EDN: TQKFOP doi: 10.17816/aog35266

[40] Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update. 2016;22(6):665–686. doi: 10.1093/humupd/dmw023

[41] Donnez J., Dolmans M.M. Uterine fibroid management: from the present to the future // Hum Reprod Update. 2016. Vol. 22, N 6. P. 665–686. doi: 10.1093/humupd/dmw023

[42] Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update. 2016;22(6):665–686. doi: 10.1093/humupd/dmw023

[43] Su WH, Cheung SM, Chang SP, Lee WL. Internal bleeding from a ruptured serosal vein covering the myoma surface mimicking upper gastrointestinal bleeding. Taiwan J Obstet Gynecol. 2008;47(3):352–354. doi: 10.1016/S1028-4559(08)60142-4

[44] Su W.H., Cheung S.M., Chang S.P., Lee W.L. Internal bleeding from a ruptured serosal vein covering the myoma surface mimicking upper gastrointestinal bleeding // Taiwan J Obstet Gynecol. 2008. Vol. 47, N 3, P. 352–354. doi: 10.1016/S1028-4559(08)60142-4

[45] Su WH, Cheung SM, Chang SP, Lee WL. Internal bleeding from a ruptured serosal vein covering the myoma surface mimicking upper gastrointestinal bleeding. Taiwan J Obstet Gynecol. 2008;47(3):352–354. doi: 10.1016/S1028-4559(08)60142-4

[46] Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3–13. doi: 10.1016/j.ijgo.2010.11.011

[47] Munro M.G., Critchley H.O., Broder M.S., Fraser I.S. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age // Int J Gynaecol Obstet. 2011. Vol. 113, N 1. P. 3–13. doi: 10.1016/j.ijgo.2010.11.011

[48] Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3–13. doi: 10.1016/j.ijgo.2010.11.011

[49] Levai AM, Rotar IC, Muresan D. Torsion of a uterine leiomyoma — a rare cause of hemoperitoneum; a case report and review of the literature. Med Ultrason. 2019;21(1):77–82. doi: 10.11152/mu-1784

[50] Levai A.M., Rotar I.C., Muresan D. Torsion of a uterine leiomyoma — a rare cause of hemoperitoneum; a case report and review of the literature // Med Ultrason. 2019. Vol. 21, N 1. P. 77–82. doi: 10.11152/mu-1784

[51] Levai AM, Rotar IC, Muresan D. Torsion of a uterine leiomyoma — a rare cause of hemoperitoneum; a case report and review of the literature. Med Ultrason. 2019;21(1):77–82. doi: 10.11152/mu-1784

[52] Gupta S, Manyonda IT. Acute complications of fibroids. Best Pract Res Clin Obstet Gynaecol. 2009;23(5):609–617. doi: 10.1016/j.bpobgyn.2009.01.012

[53] Gupta S., Manyonda I.T. Acute complications of fibroids // Best Pract Res Clin Obstet Gynaecol. 2009. Vol. 23, N 5. P. 609–617. doi: 10.1016/j.bpobgyn.2009.01.012

[54] Gupta S, Manyonda IT. Acute complications of fibroids. Best Pract Res Clin Obstet Gynaecol. 2009;23(5):609–617. doi: 10.1016/j.bpobgyn.2009.01.012

RIGHTS & PERMISSIONS

Eco-Vector