A CASE SERIES ON FIBROID UTERUS WITH ATYPICAL PRESENTATIONS

Abstract

Uterine fibroids (leiomyomas) are common benign tumors in women of late reproductive age and perimenopausal years. This case series presents unusual fibroid presentations, emphasizing the diagnostic challenges and surgical complexities associated with fibroids.

Case Presentations: Case 1 describes 45-year-old multiparous woman with a broad ligament fibroid (20×11.8 cm) causing abdominal distension and pelvic discomfort, confirmed on imaging. Case 2 involves a 49-year-old multiparous  woman with fibroid uterus, gallstones, and umbilical hernia, complicating surgical management. The largest fibroid measured 8×6.5 cm and intraoperative findings revealed bladder adhesions and endometriotic spots, requiring careful dissection. Case 3 presents a 48-year-old multiparous woman with urinary symptoms and mild bilateral hydronephrosis due to bladder compression from a 12×12 cm anterior fibroid. Surgical intervention required meticulous bladder dissection to prevent injury. Case 4 features 40-year-old multiparous women with intraoperative finding of false broad ligament fibroid extending upto the pelvic side wall. The ureter anatomy was completely distorted due to adhesions. Proper delineation of pelvic anatomy was required to avoid surgical complications. Case 5 reports a 43 year old, multiparous woman with atypical history of chronic constipation, rectal tenesmus and chronic pelvic pain. Examination revealed irregularly enlarged uterus  with 12.8x11.5x9.6 cm fibroid in posterior wall. Intraoperatively bulky fibroid found occupying pouch of douglas and compressing the rectum.

Conclusion: Atypical fibroid presentations require early recognition, precise imaging, and tailored surgical strategies for optimal patient outcomes. This case series underscores the need for greater awareness of fibroid-related complications beyond gynecological symptoms, ensuring timely intervention and reducing morbidity.