Successful management of torsion of subserosal uterine myoma by laparoscopic surgery

Abstract

Introduction: Uterine myoma is one of the most common diseases among gynecological benign tumors. However, the torsion of uterine leiomyoma is very rare. We reported here two cases of torsion successfully managed by laparoscopic surgery.
[Case 1] A 33-year-old nulligravid woman visited a local hospital with lower abdominal pain. Conservative therapy for suspected ovarian hemorrhage temporarily relieved her symptoms. However, 5 days later, the pain increased and she was transferred to our hospital. A solid mass with tenderness was observed on the left side of Douglas' pouch. Magnetic resonance imaging (MRI) performed at the previous hospital showed a 5-cm mass attached to the uterus. Emergency laparoscopic surgery was performed for suspected pedicle torsion of a subserous myoma. A dark red 5-cm-diameter pedunculated subserous myoma with 180° counterclockwise torsion was detected around the left round ligament. The pedicle was dissected with electrocoagulation using forceps and collected with a morcellator. The histopathological diagnosis was leiomyoma with vascular changes due to torsion.
[Case 2] A 33-year-old woman (gravida 1 para 1) suddenly experienced lower abdominal pain 7 months after vaginal delivery. After visiting a local hospital, she was referred to our hospital with a diagnosis of suspected subserous myoma degeneration. Significant abdominal tenderness was noted, and transvaginal ultrasound showed a 9-cm mass. Blood testing revealed sign of severe inflammation with a white blood cell count of 15,700/μL and C-reactive protein (CRP) level of 26.9 mg/dL. Myoma degeneration and pedicle torsion were suspected based on MRI findings. She underwent emergency laparoscopic surgery. A pedunculated subserous myoma growing from the posterior wall of the uterus with 720° clockwise torsion was observed. The pedicle was dissected with vessel sealing instrument (LigaSure™, COVIDIEN JAPAN) and collected with a morcellator. The histopathological findings showed smooth muscle cell hyalinization with hemorrhage.
Conclusion: Even uncommon in clinical practice, torsion of subserosal uterine myoma can be successfully managed by laparoscopic surgery.