Laparoscopic removal of bilateral uterine remnants for symptomatic unilateral leiomyomas in a patient with Müllerian agenesis

Abstract

Objective: To our knowledge, we present the first video demonstration of the laparoscopic removal of bilateral uterine remnants for symptomatic unilateral leiomyomas in a patient with Müllerian agenesis.

Design: A video case report.

Setting: An academic medical center.

Patient: A 44-year-old woman, gravida 0, with a history of Müllerian agenesis with presumed single uterine remnant who presented with worsening lower abdominal fullness and discomfort in the setting of known leiomyomas. Magnetic resonance imaging of the pelvis revealed a single rudimentary uterine remnant with 3 dominant leiomyomas, with the largest measuring 5.8 × 5.3 × 5.2 cm. After extensive counseling, she opted for definitive surgical management. She provided written consent for video recording and publication of this surgical case.

Intervention(s): Laparoscopic removal of bilateral uterine remnants, bilateral salpingectomy, and cystoscopy.

Main outcome measure(s): Laparoscopic removal of bilateral uterine remnants with multiple unilateral leiomyomas, leading to resolution of lower abdominal bulk symptoms.

Result(s): Diagnostic laparoscopy revealed a right 12-cm pelvic mass consisting of a uterine remnant with 3 dominant leiomyomas, left 2-cm rudimentary uterine remnant, bilateral atrophic fallopian tubes, bilateral normal ovaries, and absent cervix and upper vagina. Procedure was uncomplicated with an estimated blood loss of 25 mL. Patient was discharged on the same day of surgery after meeting required milestones. Pathologic examination of the specimens was consistent with intraoperative findings.

Conclusion(s): Müllerian agenesis is a rare congenital anomaly of the female reproductive tract in which uterine remnants may be found. Leiomyoma formation in uterine remnants is rare but possible. Magnetic resonance imaging is the most sensitive imaging modality for uterine remnants but not always accurate. When leiomyomas become symptomatic, surgery is the only definitive management option with laparoscopy as the standard of care when possible. Minor changes to the minimally invasive approach may be necessary to accommodate for anatomical differences.

Keywords: Müllerian agenesis; fibroid; laparoscopy; leiomyoma; uterine remnant.