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Unusual presentation of more common disease/injury
CASE REPORT
Management of a giant uterine leiomyoma
  1. Poh Ting Lim1,
  2. Chin How Tan2,
  3. Hui Ling Chia3,
  4. Jessie Phoon1
  1. 1Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, Singapore, Singapore
  2. 2Anaesthesiology, KK Women’s and Children’s Hospital, Singapore, Singapore
  3. 3Plastics, Reconstructive and Aesthetic Surgery, KK Women’s and Children’s Hospital, Singapore, Singapore
  1. Correspondence to Dr Poh Ting Lim, pohting.lim{at}mohh.com.sg

Summary

Uterine leiomyomas are the most common tumours arising from the female reproductive tract. However, giant myomas, which are greater than 11.4 kg in weight, are exceedingly rare. They may cause a pressure effect on surrounding organs, heart and lungs, which can be potentially life threatening. We present a case of a 53-year-old woman with a massive uterine mass complicated by restrictive lung disease. She underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy with frozen section and reconstruction of the abdominal wall by the gynaecologists and plastic surgeons. The excised specimen weighed 27.8 kg, which included a benign subserosal leiomyoma measuring 64 by 50.5 by 15 cm. Intraoperative blood loss was 7 L and her postoperative recovery was complicated by coagulopathy and haemorrhagic shock. This case illustrates the pivotal role of multidisciplinary care in the management of complicated surgical patients and the need for careful perioperative care.

  • obstetrics and gynaecology

https://doi.org/10.1136/bcr-2017-224052

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    Footnotes

    • Contributors PTL: the corresponding author took the lead and was the main writer of the manuscript. JP: was the gynaecologist who performed the surgery for this patient. She was also involved in the conception and editing of this case report. HLC: was the plastic surgery consultant who performed the abdominal reconstruction for the patient and wrote the section on technique of abdominal closure in this manuscript. CHT: was the anaesthetist who cared for the patient intraoperatively and postoperatively. He also provided critical feedback in editing the manuscript.

    • Funding The authors have not declared a specific grant for this research 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.