Unsuspected Cervical Fibroids and Bladder Injuries

Abstract Uterine fibroids, or leiomyomas, are benign tumors that are frequently encountered during reproductive ages, usually with symptoms of irregular bleeding and pelvic pain. Clinical management of fibroids may be, especially difficult in patients with a history of previous abdominal surgeries, particularly cesarean sections, because of possible anatomical distortions and adhesions. This case report illustrates a 49-year-old female with a background of two cesarean deliveries, presenting heavy menstruation and pelvic pain of 1 year. Imaging diagnosed the presence of large subserous fibroid and, during surgical intervention, found the mass was a cervical fibroid and, in the process, accidentally injured the bladder during dissection due to adhesion. The procedure was a total abdominal hysterectomy and bilateral oophorectomy, and postoperative care involved the insertion of an indwelling Foley catheter for 3 weeks to allow healing of the bladder. Histopathological diagnosis revealed multiple small ovarian cysts, leiomyoma, and chronic cervicitis without malignancy. This case highlights the nuances of surgically managing cervical fibroids in patients with previous abdominal surgery and misleading imaging. Preoperative imaging and ureteric stenting can prevent injuries during fibroid surgery. Bladder cystoscopy is usually unnecessary since fibroids do not typically complicate bladder anatomy. In our case, imaging showed no abnormalities with the cervix or bladder, so we did not isolate the ureters. In addition, the absence of unilateral tubes, round ligaments, and ovaries complicated intraoperative anatomy identification. In general, this report underscores the importance of precise diagnosis and preoperative evaluation along with meticulous dissection in guaranteeing positive surgical results in patients with cervical fibroids. The identification of a bladder injury is important and undiagnosed perioperative bladder injuries cause significant morbidity.