Incidental finding of pre-peritoneal leiomyoma during laparoscopic hysterectomy: a case report and literature review

Pre-peritoneal leiomyomas are extremely rare, and only a few case reports had been published in recent years. They are often misdiagnosed preoperatively as subserous leiomyomas or ovarian tumors and found intraoperatively to be pre-peritoneal masses. We here describe a case of a 47-year-old woman with no history of surgery or hormonal therapy who presented with menostaxis and progressively worsening menorrhagia. Preoperative transvaginal sonography suggested multiple uterine leiomyomas and laparoscopic hysterectomy was scheduled. During the laparoscopy, the gynecologist discovered a pre-peritoneal leiomyoma on the right pelvic that had no connection with her uterus and resected it laparoscopically. Histological examination showed that the abdominal mass was a leiomyoma with no features of malignancy, consistent with the uterine findings. The successful outcome in this case demonstrates that the abdominopelvic cavity should be thoroughly inspected during laparoscopic surgery to avoid delayed diagnoses and forestall second operation. It also shows that laparoscopic resection of pre-peritoneal leiomyomas is feasible when they are located between the peritoneum and muscularis layer. Similar published cases are also briefly reviewed.