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Management of Giant Cervical Fibroid By “Hybrid Technique”
Cervical fibroids are a rarity as compared to fibroids arising from other parts of the uterus. These rare fibroids account for 1-2% of all fibroids. They arise from supravaginal or vaginal portion of cervix. They can be either anterior, posterior, central or lateral. Our case is unique in many ways, firstly the huge size of the tumor, its rapid growth and its management laparoscopically. We report a case of 47-year-old female who presented with complain of pain abdomen and menorrhagia since last 10 years. Abdominal examination revealed a huge firm mass corresponding to 34 weeks size gravid uterus with well defined margins. The lower pole of the mass could not be reached and mobility was not there due to its size. MRI revealed a large fibroid arising from the posterior wall of the cervix displacing the uterus to the left and anteriorly. After necessary investigations, arranging adequate blood and written informed consents, patient was taken up for laparoscopic hysterectomy. Intraoperative findings were of a large cervical fibroid seen extending from depth of the pelvis uptil four inches below xiphisternum and abutting right lateral wall. Uterus was deviated to the left side by the tumor. Left tube and ovary were normal looking, but right tube was stretched over the tumor along with the ovary. Hysterectomy was done including the separation of the fibroid from all its attachments, but in view of large size of the mass and high suspicion of sarcomatous changes within the tumor, laparotomy was done to deliver out the tumor with uterus and bilateral adnexa. The operative time was around 3 hours and estimated blood loss during the surgery was around 500ml. Patient was given 2 units of PCV and 2 units of FFP’s. Her postoperative period was uneventful. Histopathology report was in conformity with that of a cervical fibroid. To conclude, management of such cases laparoscopically helps in decreasing blood loss during surgery to a large extent and helps in decreasing patient morbidity in the hand of experienced endoscopist team.
Kanika Chopra, Debasis Dutta, Kanika Jain