Management of a large uterine fibroid arising from the cervical stump following subtotal hysterectomy causing massive abdominal distension. A rare case report and review of the current literature.

INTRODUCTION AND IMPORTANCE

A cervical stump fibroid is a rare type of leiomyoma (fibroid) that occurs in the remaining cervical tissue following a subtotal hysterectomy. In this procedure the uterus is removed but the cervix is left intact. Cervical stump fibroids are quite rare, with studies indicating that they occur in less than 1 % of women who have undergone subtotal hysterectomy. The present report describes a rare case of uterine fibroid arising from the cervical stump 7 years after subtotal hysterectomy. The aim is to strengthen the existing literature and aid clinicians in the management of similar cases.

CASE PRESENTATION

A 45-year-old female presented with a history of abdominal distension, abdominal pain, and bilateral lower limb swelling for 1 year. An abdominal Computed Tomography (CT) scan with contrast and Magnetic Resonance Imaging (MRI) revealed a large multilobulated mass in the pelvis measuring 14.3 × 7.4 × 21.1 cm. The mass displaces and compresses the urinary bladder anteriorly and the rectosigmoid colon posteriorly. Additionally, there is compression of the distal ureters bilaterally with resultant bilateral hydroureteronephrosis. The patient underwent explorative laparotomy and post-operative recovery was uneventful. The final histopathological report showed the diagnosis of uterine fibroid.

CLINICAL DISCUSSION

In this case report, we discuss the condition's rarity, related reports in the literature, and the numerous difficulties clinicians face when encountering a patient with cervical leiomyomas.

CONCLUSION

This case highlights the importance of long-term follow-up for patients post-supracervical hysterectomy, adds to the existing literature, and provides insight to healthcare providers in handling similar cases. Patients who are affected should receive appropriate counseling on postoperative care, recurrence after treatment, and the value of early and regular follow-up visits.