Huge Broad Ligament Fibroid with Paracervical Extension: A Safe Approach by Same Setting Myomectomy before Hysterectomy

Abstract

The broad ligament is the most common extrauterine site for leiomyoma but with low incidence rate. We present a patient with complaints of lower abdominal pain and abdominal distension. Abdominal examination revealed a huge firm mass arising from the pelvis corresponding to 24-week size. The cervix was deviated and elevated but felt separable of the mass. Ultrasonographic examination showed 20 cm fibroid beside the uterus suggesting broad ligament fibroid. On laparotomy, the uterus was elevated up and deviated laterally by the mass. A 20 cm broad ligament fibroid was seen extending deep in the pelvis and up filling all the broad ligament. Myomectomy was performed initially to decompress the mass for easy hysterectomy and carefully evaluating the ureter avoiding its injury. Total hysterectomy with bilateral salpingo-oophorectomy was done. This case was reported because of the rare incidence of broad ligament leiomyoma and the difficulty in its operative management.

Keywords: Broad ligament; fibroid; hysterectomy; myomectomy.

Figure 1

Huge broad ligament fibroid with hysterectomy specimen

Figure 2

Ultrasound showing large uterine fibroid with ring of fire around