卵巣出血との鑑別を要した漿膜下子宮筋腫茎捻転の1症例

抄録

  We report a case of torsion of a subserosal leiomyoma necessitating distinction from ovarian hemorrhage.

  A 34-year-old woman presented to the emergency room of a hospital with acute abdominal pain for the past 3 months. Computerized tomography (CT) revealed an enlarged left ovary and ascites. She was diagnosed with ovarian hemorrhage, and was subsequently followed up. A magnetic resonance imaging (MRI) performed 2 months later, revealed a left hemorrhagic ovarian cyst leading to the suspicion of a persistent ovarian hemorrhage. Owing to an unrelieved chronic abdominal pain even after 3 months of onset, she was transferred to our hospital. Transvaginal ultrasonography showed normal ovaries bilaterally. A tumor of size 36 mm was detected to the left of the uterus, which accounted for tenderness. Surgery was recommended, for which the patient consented 4 months after the onset of symptoms. Laparoscopic surgery was performed; the tumor adhered to the left uterine adnexa and the uterus. However, no pedicle or vascular connection to the uterus was observed. Following adhesiolysis, the left ovary was confirmed to be normal and laparoscopic myomectomy was conducted. Histopathology revealed necrosis of the myoma. Based on the clinical course and intra-operative findings, torsion of the subserosal myoma was speculated and the myoma was detached from the uterus. In case of acute or chronic abdominal pain with myoma, laparoscopic surgery should be considered when imaging precludes accurate diagnosis.