Leiomyomatosis peritonealis disseminata (LPD) is a rare complication of uterine fibroids characterized as multiple nodules studding the pelvis. LPD appears to develop from either metaplasia of subperitoneal mesenchymal stem cells under hormonal stimulation or from a hereditary predisposition. Further, surgical involvement in the development of LPD has been highly considered with power morcellation. This report summarizes a case of surgical LPD after robotic myomectomy using power morcellation.METHODS:
A forty one year old female presented with complaint of abdominal pain three months after cesarean delivery.RESULTS:
At initial evaluation, the patient noted intermittent, sharp periumbilical pain and a mass. CT scan of abdomen and pelvis demonstrated multiple omental implants and pelvic soft tissue masses suggesting carcinomatosis. CT guided biopsy was non-diagnostic. Surgical evaluation was recommended following normal tumor marker testing. Diagnostic laparoscopy showed multiple benign pelvic tumors. Extensive adhesions precluded laparoscopic resection. Exploratory laparotomy was performed with hysterectomy, bilateral salpingectomy, lysis of adhesions, and removal of over thirty peritoneal leiomyomatas. Pathology revealed benign smooth muscle tumors consistent with LPD.CONCLUSION:
Morcellation is described as a surgical cause of LPD in less than twenty five reported cases. Our patient had a history of robotic myomectomy with power morcellation prior to her presentation for abdominal pain. Imaging demonstrated multiple pelvic masses concerning for carcinomatosis. Surgical evaluation confirmed LPD. The implants were impressive in size and number. Additionally, a subcutaneous implant was noted at a previous laparoscopic site. This finding further suggests morcellation as the etiology of our patient's LPD.