Leiomyoma: a rare cause of small bowel obstruction

Rare Presentation of Small Bowel Obstruction Secondary to Intestinal Leiomyoma in a Patient with Crohn's Disease

Small bowel obstructions (SBOs) are surgical emergencies that can occur with mechanical blockage of the intestinal lumen. These blockages are most commonly caused by adhesions or hernias, but can also result from intestinal neoplasms. This case report documents the rare occurrence of SBO due to a submucosal leiomyoma. This case was complicated by the patient's longstanding history of Crohn's disease, which has a considerable overlap in symptomatology with SBOs. This may have resulted in a delay in the patient's diagnosis. Leiomyomas should always be considered as a potential, albeit rare, cause of SBO.

Twisted Mesenteric Leiomyoma Mimicking Acute Appendicitis

Leiomyoma is a benign tumor of smooth muscles and can essentially arise from any part of the body that contains smooth muscles. It is more commonly found in the uterus, while those from the gastrointestinal tract are rare. The spectrum of clinical presentation is rather wide, from a vague abdominal discomfort or acute abdomen mimicking more common diagnoses such as acute appendicitis or acute gastroenteritis to features of intestinal obstruction and gastrointestinal bleeding. Here, we share our experience with a case of a young woman whose symptoms and signs were typical of acute appendicitis, which intraoperatively turned out to be a twisted mesenteric tumor located at 70 cm from duodenojejunal flexure. The tumor was managed by segmental resection and anastomosis. She had an uneventful recovery postoperatively, and histopathological examination of the surgical specimen was consistent with an infarcted mesenteric leiomyoma. The rarity of this entity mimicking appendicitis is highlighted, and should it never get twisted, it would have probably remained unnoticed for the rest of her life. In the current era of laparoscopy, it is always wise to never skip a thorough examination of the whole length of the small bowel in order to locate this type of pathology.

Fibroid expulsion: a unique presentation of mechanical small bowel obstruction 11 years after uterine artery embolization: a case report

Background

Uterine artery embolization in the treatment of uterine leiomyoma has been rarely associated with dislodgement and expulsion of infarcted uterine fibroids through the vagina, peritoneum, or bowel wall, predominantly occurring within 6 months of uterine artery embolization.

Case presentation

We present the case of a 54-year-old African American woman who underwent uterine artery embolization 11 years prior and developed mechanical small bowel obstruction from the migration of fibroid through a uteroenteric fistula with ultimate impaction within the distal small bowel lumen. Small bowel resection and hysterectomy were curative.

Conclusions

Uteroenteric fistula with small bowel obstruction due to fibroid expulsion may present as a delayed finding after uterine artery embolization and requires heightened awareness.