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Reminder of important clinical lesson
CASE REPORT
Uterine fibroid or ovarian fibroma: importance of comprehensive preoperative consent-taking to include unexpected findings with management implications
  1. Lee Koon Kwek1,
  2. Wei-Wei Wee-Stekly2,
  3. Su Min Bernard Chern2
  1. 1 Department of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, Singapore
  2. 2 Department of Minimally Invasive Surgery, KK Women’s and Children’s Hospital, Singapore
  1. Correspondence to Dr Lee Koon Kwek, leekoon.kwek{at}mohh.com.sg

Summary

A 35-year-old woman presented with an abdominal mass found incidentally on an ultrasound scan. On examination, the uterus was mobile and 14 weeks in size. Further imaging showed a large subserosal pedunculated fibroid, and she was counselled for laparoscopic myomectomy, morcellation in a bag, kept in open view. Intraoperatively, the mass was noted to be arising from the right ovarian ligament instead of the uterus, and decision was made to convert to open surgery. This case highlights important issues of consent-taking preoperatively and critical points to note regarding change in operative consent intraoperatively. This also highlights the importance of multidisciplinary cooperation as the decision had to be made with inputs made from gynae-oncology and pathology.

  • obstetrics and gynaecology
  • ethics
  • healthcare improvement and patient safety

https://doi.org/10.1136/bcr-2017-222608

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    Footnotes

    • Contributors LKK contributed to the development of the research design, analysis strategy, data collection, statistical analysis and interpretation of results. Both W-WW-S and SMBC contributed to the development of research design and analysis strategy and provided editorial guidance for this manuscript.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.