General Surgery, Lewisham and Greenwich NHS Trust, London, UK
General Surgery, Lewisham and Greenwich NHS Trust, London, UK.
BMJ Case Rep. 2021 Jan 27;14(1):e232797. doi: 10.1136/bcr-2019-232797.
A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.
一位 39 岁的多产非裔加勒比女性因突发性剧烈右髂窝疼痛到急诊科就诊。她的炎症标志物略有升高。腹部计算机断层扫描显示右髂窝脂肪纹理特征，疑似急性阑尾炎。该扫描还注意到子宫平滑肌瘤。患者被送往手术室进行紧急诊断性腹腔镜检查，发现阑尾大体正常。在右侧附件中可见到坏死的重度钙化寄生性平滑肌瘤，与子宫分离，附着于大网膜上长而扭曲的蒂上。寄生性平滑肌瘤成功地分块切除。平滑肌瘤的并发症，即扭转和坏死，是突发性下腹痛女性的重要鉴别诊断。突然出现严重的下腹痛病史，并有已知平滑肌瘤背景的情况下，应促使主治医生考虑平滑肌瘤并发症作为鉴别诊断的一部分。
