腹腔鏡下手術が有用であった発症からの時間経過が異なる漿膜下子宮筋腫茎捻転の3例

抄録

Objective: To report three cases of subserosal leiomyoma torsion at different phases (time from onset).

Design: Case report

Patients: Patients included a 45-year-old, a 38-year-old, and a 28-year-old woman

Interventions: Computed tomography, magnetic resonance imaging (MRI), and laparoscopic surgery

Results: Case 1: A 45-year-old female patient visited our hospital with a chief complaint of lower abdominal pain persisting for 3 days. Emergency laparoscopic surgery revealed a dark-red subserosal leiomyoma on the posterior uterine wall extending into the left posterior cornual region. The leiomyoma pedicle was twisted 180-degree clockwise.

Case 2: A 38-year-old female patient developed lower right abdominal pain persisting for 7 days, which was treated as appendicitis. MRI revealed a 6 × 5-cm subserosal leiomyoma without enhancement on the right side of the uterus. Emergency laparoscopic surgery revealed that the leiomyoma was adhered to the greater omentum; moreover, a mildly weak adhesion was detected on the right side of the abdominal wall. The leiomyoma pedicle was twisted 180-degree anticlockwise.

Case 3: A 28-year-old female patient with a leiomyoma was referred to our hospital for surgery owing to chronic abdominal pain and worsening dysmenorrhea. MRI with contrast enhancement revealed a 10-cm subserosal leiomyoma on the anterior uterine wall. Laparoscopic surgery indicated an ischemic leiomyoma with extensive and tight adherence to the greater omentum and retroperitoneum. The twisted subserosal leiomyoma pedicle had not been expected preoperatively.

Conclusion: A subserosal leiomyoma torsion developed extensive and tight adherence as time progressed from onset. Laparoscopic surgery is useful in not only the acute phase, but also in the chronic phase of pedunculated subserosal uterine leiomyoma torsion.