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Abu Hashim, H., Al Khiary, M., & EL Rakhawy, M. (2020). Laparotomic myomectomy for a huge cervical myoma in a young nulligravida woman: A case report and review of the literature. International Journal of Reproductive BioMedicine (IJRM), 18(2), 135–144. https://doi.org/10.18502/ijrm.v18i2.6421

https://doi.org/10.18502/ijrm.v18i2.6421

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  • Cited by 2 articles

authors

  • Hatem Abu Hashim

    Hatem Abu Hashim

    Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
  • Moustafa Al Khiary

    Moustafa Al Khiary

    Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
  • Mohamed EL Rakhawy

    Mohamed EL Rakhawy

    Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Published Date

  • Mar 15, 2020

Laparotomic myomectomy for a huge cervical myoma in a young nulligravida woman: A case report and review of the literature

International Journal of Reproductive BioMedicine (IJRM) / International Journal of Reproductive BioMedicine (IJRM): Volume 18, Issue No. 2 / Pages 135–144

Abstract

Background: A huge cervical myoma (rare) in a young woman is a nightmare of every gynecologist owing to the associated technical challenges in performing a myomectomy. Moreover, the 2014 US Food and Drug Administration prohibited power morcellation during laparoscopic myomectomy due to the inadvertent spread of occult malignancy and an increased risk of iatrogenic parasitic leiomyoma negatively affected the overall rate of a minimally invasive surgery.


Case: This report described our experience with a case of a huge anterior cervical myoma (473 gr) in a young nulligravida woman who successfully underwent laparotomic myomectomy. After an initial diagnosis by Magnetic resonance imaging (MRI), we performed preoperative ureteric catheterization. The myoma was enucleated following the footsteps of Victor Bonney, the pioneer of myomectomy, combined with simple additional steps. We did not use preoperative gonadotropin-releasing hormone analog, intraoperative vasopressin injection, or uterine artery ligation. A 6-month follow-up MRI revealed an intact cervical canal in midline position with no evidence of residual fibroid.


Conclusion: Based on our experience, the review of the relevant literature, and the US Food and Drug Administration's prohibition of power morcellation during laparoscopic myomectomy, a laparotomic myomectomy for a huge cervical myoma still plays a vital role in fertility preservation. We propose the mnemonic "MUSIC" as a helpful guide for a consistent strategy: M (preoperative MRI), U (prophylactic ureteric catheterization), S (shell out the myoma following Bonney's principles i.e. start-up and stay intracapsular), I (immediate suction to clarify dead space) and C (close the cavity by spiraling stitch).


Key words: Cervix, Fibroid, Leiomyoma, Myomectomy.

References
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