Management of a Giant Myomatous Uterus in a 39-Year-Old Female: A Surgical Case Report

Introduction Uterine leiomyomas are the most common benign tumors of the uterus, often asymptomatic and managed conservatively. However, large or symptomatic leiomyomas may require surgical intervention. The choice between laparoscopic and open hysterectomy remains a subject of debate, particularly for massive tumors. This report details the case of a 39-year-old female with a 2200 g myomatous uterus successfully managed with laparoscopic subtotal hysterectomy and bilateral salpingectomy. Case Presentation A 39-year-old female presented with progressive abdominal distension, pelvic pain, and heavy menstrual bleeding. Examination revealed a distended abdomen resembling a late-term pregnancy. Imaging confirmed a >25 cm intramural leiomyoma with mass effect on adjacent structures but no signs of malignancy. Preoperative optimization included anemia correction with IV iron and transfusion. Laparoscopic subtotal hysterectomy with bilateral salpingectomy was performed, excising a 2200 g myomatous uterus while preserving the ovaries. The procedure was complicated by distorted anatomy and increased vascularity due to tumor size. Discussion Uterine fibroids are the most prevalent benign tumors in women, often leading to significant morbidity, including abnormal bleeding, pelvic pain, and infertility [1,2]. The management strategies for these conditions have evolved, emphasizing the need for personalized approaches based on the patient's symptoms, age, and reproductive desires [2,3]. Surgical options remain the cornerstone of treatment, particularly in cases where conservative management fails to alleviate symptoms. While hysterectomy remains a definitive treatment for symptomatic fibroids, myomectomy is often preferred for women wishing to retain their reproductive potential [2]. Furthermore, longterm follow-up is necessary to monitor for potential recurrence of fibroids, which can occur in a significant proportion of patients [3]. Conclusions This case highlights the importance of individualized management for giant uterine leiomyomas. In a 39-year-old female, laparoscopic subtotal hysterectomy with bilateral salpingectomy was a safe and effective approach for symptom relief and complication prevention. Multidisciplinary collaboration and careful preoperative planning were key to achieving optimal outcomes.