Recurrent Abdominal Pain Caused by a Parasitic Leiomyoma Containing Endometrial Cells Following Laparoscopic Hysterectomy

Parasitic leiomyomas are rare complications of uterine morcellation after laparoscopic hysterectomy (LH). These tumors typically consist of smooth muscle cells and are often asymptomatic. However, parasitic leiomyomas containing endometrial cells that exhibit periodic abdominal pain have not been reported previously. A 47-year-old woman presented with recurrent right lower abdominal pain two years after undergoing LH and bilateral salpingectomy for uterine leiomyoma. A contrast-enhanced computed tomography revealed a 2.5-cm mass lesion between the lateral aspect of the ascending colon and the abdominal wall. Surgical excision revealed that the mass was firmly adherent to the abdominal wall and the omentum. Histopathological examination confirmed the diagnosis of iatrogenic parasitic leiomyoma with endometrial cells composed of endometrial glands and endometrial stroma, smooth muscle proliferation, and internal hemorrhage. It was concluded that her periodic abdominal pain was caused by the menstrual-like bleeding within a parasitic leiomyoma. Postoperative recovery was uneventful, with symptom resolution. Follow-up imaging and clinical evaluations showed no recurrence.