Solitary anterior abdominal wall leiomyoma in a 31-year-old multipara woman: a case report
© Igberase et al; licensee BioMed Central Ltd. 2009
Received: 15 January 2009
Accepted: 01 February 2009
Published: 01 February 2009
Anterior abdominal wall fibroid are uncommon and could be a cause of pain and discomfort. Very few cases have been reported in the literature but none in our region.
We present an uncommon case of a 31 year old para 2+2 trader from the Itsekiri tribe of the Niger Delta region of Nigeria who presented with a one year history of a periumbilcal mass, had surgical removal of the mass and histology revealed leiomyoma.
Abdominal wall fibroid is a good differential diagnosis to be considered in any woman of reproductive age with an anterior abdominal mass and previous uterine surgery, including laparoscopic surgeries.
Fibroids also called leiomyoma are said to be the commonest benign tumour of the reproductive tract and are clinically apparent in 20% of women of reproductive age. The may be present in as many as 70% of uteri removed at hysterectomy . The commonest site is the uterus but they are also found in the broad ligament, ovaries, vagina and rarely on the anterior abdominal wall [2–5]. Uterine fibroids are associated with infertility, menorrhagia, pain and compression symptoms when very large [2, 6]. Abdominal wall fibroids are an uncommon finding and are thought to follow seeding following surgical resection of uterine fibroids [4, 7, 8]. With the advent of laparoscopic myomectomies, more cases of abdominal wall fibroids are now being reported.
We present an unusual case of abdominal wall leiomyoma in a 31 year old multipara with 2 previous Caesarean sections and no evidence of uterine fibroid.
We present a case of a 31 year old para 2+2 (3 alive) female trader from the Itsekiri tribe in the Niger Delta region of Nigeria. She was first seen at the gynaecological clinic with a one year history of progressive periumbilical swelling which later became associated with pain. The mass at initial presentation measured about 2.0/1.5 cm and a year later became 10.0/8.0 cm. It was located on the left periumbilical area, roundish, mildly tender, firm, slightly mobile and not attached to the skin or underlying tissue. She has 3 living children having had a set of twin and both deliveries were by Caesarean section. Indications for her 2 previous Caesarean sections were twin gestation and cephalopelvic disproportion respectively There were no findings of uterine fibroids from previous ultrasound scans and Caesarean sections done. Abdominopelvic scan done at presentation was essentially normal except for the anterior abdominal wall mass measuring 100 mm/96 mm of mixed echogenicity suggestive of anterior abdominal wall cyst or fibroid.
There is paucity of findings of isolated abdominal wall fibroids in the literature without previous surgeries for myomectomies or presence of uterine fibroids. She has never been managed for infertlity nor has any diagnosis of uterine fibroids been made. Indications for her 2 previous Caesarean sections were twin gestation and cephalopelvic disproportion respectively. There was no evidence of uterine fibroids in all surgeries. This supports the thinking that leiomyomas can be found anywhere there are smooth muscles .
Abdominal wall fibroids are commoner after laparoscopic surgeries are done compared to open surgeries [4, 7, 8]. Incarceration of a sessile uterine fibroid in an umbilical hernia during pregnancy has been described .
This is the first reported case of abdominal wall leiomyoma in the medical literature from this region. Laparoscopic myomectomies are not widely done in our country because of lack of skills so many gynaecologist resorts to open myomectomies. This may be the reason why it is not common. The uniqueness of this case is the fact that the patient does not have uterine fibroid. There is the possibility that uterine seeding into the abdominal wall could have occurred in one of the Caesarean sections.
Surgical removal was the mode of treatment and she did well postoperatively with disappearance of symptoms of pain.
In conclusion, abdominal wall fibroid is a good differential diagnosis to be considered in any woman of reproductive age with an anterior abdominal mass and previous uterine surgery, including laparoscopic surgeries.
Written informed consent was obtained from the patient for publication of this case presentation and accompanying image. A copy of the written consent is available for review by the editor-in-chief of this journal.
- Kjerulff KH, Langenberg P, Seidman JD, Stolley PD, Guzinsky GM: Uterine leiomyomas. Racial differences in severity, symptoms and age at diagnosis. J Reprod med. 1996, 41 (7): 483-90.PubMedGoogle Scholar
- Stewart EA: Uterine fibroids. Review Lancet. 2001, 357 (9252): 293-8. 10.1016/S0140-6736(00)03622-9.View ArticlePubMedGoogle Scholar
- Seims AD, Lube MW: Incarceration of a sessile uterine fibroid in an umbilical hernia during pregnancy. Hernia.Google Scholar
- Moon HS, Koo JS, Park SH, Park GS, Choi jg, Kim SG: Parasitic leiomyoma in the abdominal wall after laparoscopic myomectomy. Fertil Steril. 2008, 90 (4).Google Scholar
- Muffly T, Vadlamani I, Weed JC: Massive leiomyma of the broad ligament. Obstet Gynecol. 2007, 109 (2 pt 2): 563-5.View ArticlePubMedGoogle Scholar
- Schwartz Z, Dgani R, Katz Z, Lancet M: Urinary retention caused by impaction of leiomyoma in pregnancy. Acta Obstet Gynecol Scand. 1986, 65 (5): 525-6.View ArticlePubMedGoogle Scholar
- Lalor PF, Uribe A, Daun GS: Denovo growth of a large preperitoneal lipoleiomyoma of the anterior abdominal wall. Gynecol Oncol. 2005, 97 (2): 719-21. 10.1016/j.ygyno.2005.01.050.View ArticlePubMedGoogle Scholar
- Ostrzenski A: Uterine leiomyoma particle growing in an abdominal wall incision after laparoscopic retrieval. Obstet Gynecol. 1997, 89 (5 pt 2): 853-4. 10.1016/S0029-7844(97)81428-7.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.