Ileus, pregnancy or leiomyoma? A case of a large intraabdominal tumor

Authors evaluate a case of an extremely large leiomyoma, its symptomatology, diagnosis and surgical treatment. They present the possible peroperative complications and emphasize the necessity of the interdisciplinary approach.

The set of patients consists of 21 patients with leiomyomas of various localizations. All patients were operated by means of conventional operation. The material was sent for classical bioptic examination with the use of immuno-histochemical analysis.

Unlike found in literature, the most common appearance of leiomyoma in our set of patients was on small bowel, namely 10 of 21 patients had tumors in this localization. Furthermore there were three tumors of gynecological origin. Two of them had acute abdominal disease (AAD) while in these cases, ileus was a reason for urgent operations. In all three gynecological cases it was difficult to diagnose preoperatively the origin of tumors. In one patient, the preparation led to partial iatrogenic lesion of left ureter which was subsequently treated with primary suture. The authors describe zero mortality.

Despite the relatively simple diagnosis of leiomyomas, in some cases of extreme size of the tumor combined with its localization in the small pelvis makes it difficult to distinguish it from other mesenchymal tumors. In order eliminate the peroperative complications it is possible to introduce a urethral catheter and to set up a multidisciplinary operation team to achieve combined experience (Fig. 5, Ref. 14).