SGHGroup :: Aseer Hospital

nA Saudi female patient 46y with 3 living children was referred to OB/Gyne clinic with a huge PAM with abdominal distension & lower abdominal pain for 2 year.

Exam of the mass revealed 34 w gestation size, firm in consistency, mobile from side to side, not tender with movement with cervical motion

Ultrasound study showed:

multiple small fibroids in the uterus
Left ovary: was free
Right ovary: was not visualized
Huge PAM showing heterogeneous echo pattern with plane of cleavage between the uterus and the mass.
I.V.P showed
Right ureteric displacement to the left.
UB compression & deviation.
No back pressure changes

nExploratory laparotomy was done

A huge Rt. pedunculated SSF (pseudo broad lig. fibroid) measuring 38X22X 14cm extending from the urinary bladder to the lower edge of liver.
Another Lt. pedunculated SSF (pseudo broad lig. fibroid) measuring 18X14X11 cm post. to the larger mass.
Uterine body with multiple small fibroids was displaced towards the left.

nTAH & BSO was done for this patient, the main problem in this case was the markedly distorted anatomy with marked adhesions between the mass & the surrounding organs.
nTotal mass weight was 8300 gm.