The Twisted Uterus: Case Report and Review of Literature of Giant Uterine Fibroid

Abstract Fibroid or leiomyoma are the most common benign tumors that affect female reproductive system. Diagnosis is usually not missed in view of wide spread use of ultrasound (USG) modalities. Hence, missing a large giant leiyomyoma is very rare even in developing countries such as India unless its patient factor. We report the case of 43-year-old perimenopausal women who came to our outpatient department with complaints of mass per abdomen for 4 months and abdominal discomfort. The patient had no significant past history of any medical illness. On examination, mass was corresponding to 32 weeks size of gravid uterus. Magnetic resonance imaging done confirmed the diagnosis of fibroid arising from the uterus. USG-guided biopsy was done to rule out leiomyosarcoma and negative for malignancy. Subsequently, the patient was operated after thorough work up and total abdominal hysterectomy and bilateral salpingo oophorectomy was done. Intraoperatively, there were multiple fibroids of solid cystic consistency with bosselated appearance of varying sizes, i.e., 15 cm × 14 cm, 16 cm × 10 cm, and 10 cm × 8 cm. Total weight of the specimen was 4.8 kg. Patient withstood the procedure well and discharged on the 6 th postoperative day. Histopathology report collected which confirmed diagnosis of benign fibroid and cells negative for malignant cells. The use of clinical and diagnostic devices, especially USG, in this case, is indispensable. In conclusion, the growth of a giant fibroid can have disastrous effects on a woman’s health, including surgical trauma and psychological issues.