Disseminated Peritoneal Leiomyomatosis after Morcellation

Abstract

Disseminated peritoneal leiomyomatosis (DPL) is a rare condition characterized by the development of smooth muscle nodules throughout the peritoneal cavity. The disease may result from iatrogenic seeding of the peritoneal cavity after morcellation of leiomyomas. Although it is generally a benign condition, it may be associated with significant complications. A 34-year old woman had previously undergone multiple myomectomies to improve fertility, however their recurrence prompted a laparoscopic subtotal hysterectomy with morcellation. Investigations for continued pain revealed a large fibroid abutting the sigmoid colon, and smaller fibroids through the abdomen. At reoperation, multiple fibroids were removed from the anterior abdominal wall, pelvic sidewalls and sacral promontory. A large bowel resection with was required to remove two large fibroids attached to the sigmoid colon. This case demonstrates a potential complication of DPL resulting from morcellation. It reinforces the importance of comprehensive patient counseling when selecting surgical management options for fibroids.