Torsion of an iatrogenic parasitic fibroid related to power morcellation for specimen retrieval.

Deepa Maheswari Narasimhulu, Eugene E, Sumit S
Journal of the Turkish German Gynecological Association · 2015 · doi:10.5152/jtgga.2015.15093 · PMID:26692779 · PMC4664220
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This case report describes a rare instance of torsion in an iatrogenic parasitic fibroid resulting from prior power morcellation, highlighting the risk of severe acute pain and potential complications like necrosis.

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This case report describes a 40-year-old woman presenting with severe abdominal pain due to the torsion of a parasitic fibroid, a rare complication following power morcellation during a hysterectomy eight years prior. Magnetic resonance imaging identified degenerating parasitic tissue, leading to surgical intervention after conservative management failed to resolve persistent symptoms. The authors highlight that torsed ischemic fibroids can progress to necrosis and gangrene, potentially causing life-threatening coagulopathy or peritonitis if not recognized promptly. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

Parasitic fibroids are generally diagnosed incidentally at the time of surgery performed for symptomatic uterine fibroids. Torsion of a parasitic fibroid causing severe acute onset pain is extremely rare. We report a torsed parasitic fibroid in a patient who underwent hysterectomy using power morcellation for specimen retrieval. A 40-year-old patient with a history of laparoscopic supracervical hysterectomy 8 years prior presented with severe abdominal pain. She was diagnosed with degenerating parasitic fibroids on magnetic resonance imaging and was managed conservatively. Surgery was performed 3 days later for persistent pain, and the parasitic fibroid was found to have undergone torsion. Torsed ischemic fibroids can undergo necrosis and gangrene and can potentially cause life-threatening coagulopathy and peritonitis. Awareness of this potential complication will reduce errors in diagnosis and facilitate timely management.
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ABSTRACT Parasitic fibroids are generally diagnosed incidentally at the time of surgery performed for symptomatic uterine fibroids. Torsion of a parasitic fibroid causing severe acute onset pain is extremely rare. We report a torsed parasitic fibroid in a patient who underwent hysterectomy using power morcellation for specimen retrieval. A 40-year-old patient with a history of laparoscopic supracervical hysterectomy 8 years prior presented with severe abdominal pain. She was diagnosed with degenerating parasitic fibroids on magnetic resonance imaging and was managed conservatively. Surgery was performed 3 days later for persistent pain, and the parasitic fibroid was found to have undergone torsion. Torsed ischemic fibroids can undergo necrosis and gangrene and can potentially cause life-threatening coagulopathy and peritonitis. Awareness of this potential complication will reduce errors in diagnosis and facilitate timely management.

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