title: Laparoscopic approach to fibroid torsion presenting as an acute abdomen in pregnancy.
abstract: Uterine leiomyomas (fibroids) are seen in up to 4% of pregnancies, and most commonly present with pain in pregnancy, which can be due to red degeneration or torsion. Most cases previously have been managed with open resection. We report the case of a 35-y-old primagravida woman, presenting with acute lower abdominal pain at 11 wk gestation. Ultrasound demonstrated an 8-cm fibroid only. She demonstrated features of lower abdominal peritonitis and was scheduled for a diagnostic laparoscopy. At operation, a torsed subserosal fibroid was found. She successfully underwent laparoscopic myomectomy with the endoGIA vascular stapler and subsequent Pfannenstiel delivery. The patient was discharged 48 h postoperatively to continue her pregnancy. This case demonstrates the safe application of laparoscopic excisional myomectomy in the first trimester of pregnancy. Previously reported cases in the literature have focused on open resection or bipolar diathermy enucleation and morcellation. A high degree of suspicion should be maintained for the diagnosis in patients presenting to the surgical service with acute lower abdominal peritoneal signs during pregnancy.
authors.affiliation: Department of General Surgery, Kingston Hospital, Kingston-upon-Thames, Surrey KT2 7QB, UK. a.currie@imperial.ac.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Currie
authors.affiliation: Department of General Surgery1 Kingston Hospital, Kingston-upon-Thames, Surrey, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bradley
authors.affiliation: Department of General Surgery1 Kingston Hospital, Kingston-upon-Thames, Surrey, UK.
authors.forename: Marcus
authors.initials: M
authors.lastname: McEwen
authors.affiliation: Department of Obstetrics and Gynaecology2 Kingston Hospital, Kingston-uponThames, Surrey, UK.
authors.forename: Nawar
authors.initials: N
authors.lastname: Al-Shabibi
authors.affiliation: Department of General Surgery1 Kingston Hospital, Kingston-upon-Thames, Surrey, UK.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Willson
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology*; D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007889:Leiomyoma / Q000150:complications* / Q000601:surgery*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000601:surgery*; D014102:Torsion Abnormality / Q000150:complications* / Q000601:surgery*; D014591:Uterine Diseases / Q000150:complications* / Q000601:surgery*; D063186:Uterine Myomectomy / Q000379:methods*; D014594:Uterine Neoplasms / Q000150:complications* / Q000601:surgery*