title: Chronic anorexia and weight loss due to extensive fibroid compression of the bowel: an unusual complication of uterine fibroids in a patient with a twin pregnancy.
abstract: A 36-year-old homeless Eritrean nulliparous woman was admitted to hospital, with abdominal pain, nausea and loss of appetite. She was found to be 17 weeks pregnant with dichorionic diamniotic twins. She was cachectic and had large palpable uterine fibroids. An extensive search for infection and malignancy did not yield any significant results. She was managed with enteral nutritional support and delivered healthy twins by emergency caesarean section at 36 weeks' gestation. She re-presented 19 days postpartum, with fever and abdominal pain. Imaging revealed multiple abdominal collections and large degenerating fibroids. At laparotomy, the fibroids were found to be adherent to, compressing and enveloping large sections of bowel. The patient required a right hemicolectomy, small bowel resection and total abdominal hysterectomy. Histology confirmed an infarcted leiomyoma and the patient made a good postoperative recovery.
authors.affiliation: Department of Women's Health, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.
authors.forename: Bhaskar
authors.identifier: http://orcid.org/0000-0001-5672-4612
authors.initials: B
authors.lastname: Narayan
authors.affiliation: Department of Women's Health, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.
authors.forename: Fergus
authors.initials: F
authors.lastname: McCarthy
authors.affiliation: Department of Women's Directorate Office, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Nelson-Piercy
mesh_terms: D000328:Adult; D000855:Anorexia / Q000209:etiology*; D002585:Cesarean Section / Q000009:adverse effects; D019017:Eritrea; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007081:Ileostomy; D007410:Intestinal Diseases / Q000209:etiology / Q000601:surgery*; D007889:Leiomyoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D011247:Pregnancy; D059285:Pregnancy, Twin; D018805:Sepsis / Q000175:diagnosis* / Q000601:surgery; D063186:Uterine Myomectomy; D015431:Weight Loss