Leiomyomatosis peritonealis disseminata presenting as acute abdomen: A rare case report

Leiomyomatosis peritonealis disseminata (LPD) is an unusual condition characterized by the proliferation of uterine smooth muscle neoplasms onto the peritoneum and other organs in the abdomen. The cause is unknown, but it may be hormonal or uterine trauma. Most symptoms remain vague and are most common among women of reproductive age. Although they are not as common, acute presentations can include hemorrhagic features, which can lead to considerable suffering.

A 39-year-old para 1 with a history of one first-trimester spontaneous abortion presented with severe lower abdominal pain and vomiting for three days. Ultrasound imaging revealed a large intramural myoma and multiple subserosal myomas. Intraoperatively, a vascular, hemorrhagic nodular mass extending from an enlarged uterus to the peritoneum and omentum was found. Suspecting leiomyosarcoma, a hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathology later confirmed LPD.

LPD is a rare benign condition mimicking malignancy, often misdiagnosed due to variable presentations. Diagnosis is usually after intraoperative evaluation. While asymptomatic cases may be monitored or treated through hormonal suppression, surgical intervention is the preferred treatment modality for symptomatic or complicated cases.

LPD is an uncommon and benign lesion that may overlap with those of malignancy, such as leiomyosarcoma, and the nonspecific features on imaging and clinical presentation make it difficult to diagnose. It is conclusively diagnosed by histopathology postoperatively. It is rare, but the possibility of recurrences and malignant transformation emphasizes the need for periodicclinical and imaging surveillance.