Abstract
Leiomyomas may develop at extra‐uterine locations and pose diagnostic dile mmas. This is a case of a fibroma originating from the left round ligament presenting as a symptomatic inguinal hernia.
Keywords: inguinal hernia, laparoscopy, round ligament leiomyoma
The tumor is developing retroperitoneally, 2cm from the left side of the uterus independently of it and the ipsilateral ovary.
Leiomyomas are common uterine tumors. Occasionally, they may be found at unusual extrauterine locations developing from embryonic remnants or nonuterine pelvic smooth muscle causing problems in the differential diagnosis. 1 , 2 We present the rare case of a 26‐year‐old patient with a leiomyoma originating from the left round ligament, independently from the uterus. The patient presented with progressively deteriorating left‐sided discomfort, aggravated during exercise and heavy weight lifting. Pelvic ultrasonography revealed the presence of a solid tumor measuring 7.5 × 6.6 × 5.9 cm. No apparent connection to the uterus was detected, and differential diagnosis included pedunculated or inter‐ligamentous uterine leiomyoma versus ovarian fibroma or thecoma. At laparoscopy, it was found developing retroperitoneally 2 cm from the left side of the uterus, independently of it and the ipsilateral ovary (Figure 1). It was densely adhered to the antero‐lateral pelvic wall, the underlying retroperitoneal tissues, and the rectosigmoid. After careful retroperitoneal dissection, avoiding traumatization of the tumor through direct grasping, the proximal and distal parts of the round ligament were coagulated and cut, resulting in its complete mobilization (Figure 2). The exposed left inguinal hernia (Figure 3) which resulted from chronic tumor compression was repaired with three interrupted nonabsorbable sutures.
FIGURE 1.
The tumor is developing retroperitoneally 2cm from the left side of the uterus, independently of it and the ipsilateral ovary
FIGURE 2.
Complete mobilization of the tumor after careful retroperitoneal dissection
FIGURE 3.
Repair of the left inguinal hernia
CONFLICT OF INTEREST
The authors declare that they have no conflicts of interest and nothing to disclose.
AUTHOR CONTRIBUTIONS
KK involved in conception and study design, manuscript preparation, and patient recruitment. NK involved in data collection, statistical analysis, and patient recruitment. MT and DZ involved in data analysis and interpretation, manuscript preparation, and patient recruitment. IC served as responsible surgeon or imager. AP served as responsible surgeon or imager. All authors reviewed the results and approved the final version of the manuscript.
ACKNOWLEDGMENTS
Published with written consent of the patient.
Kypriotis K, Kathopoulis N, Tsiriva M, Zacharakis D, Chatzipapas I, Protopapas A. Leiomyoma originating from left round ligament presents as symptomatic inguinal hernia. Clin Case Rep. 2021;9:e4445. 10.1002/ccr3.4445
Institutional Review Board (IRB) Exemption: This is to certify that for the study entitled “Leiomyoma originating from left round ligament presents as symptomatic inguinal hernia” was not required institutional review board approval as it represents a case report/operative technique for which the patient involved has provided informed consent and has been informed on the possibility of anonymous publication of her case. The above decision complies with the common practices of our department “Alexandra” Hospital, 1st Department of Obstetrics & Gynecology, Medical School of the National and Kapodistrian University of Athens, Greece. Every precaution has been taken to protect the privacy and the confidentiality of the patient's personal information.
Funding information
No funding has been received by any of the authors for this work.
DATA AVAILABILITY STATEMENT
Data openly available in a public repository that issues datasets with DOIs.
REFERENCES
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data openly available in a public repository that issues datasets with DOIs.