Disseminated peritoneal leiomyomatosis following hysteroscopic leiomyoma morcellation

Background: Contained morcellation of leiomyomas within the peritoneal cavity has been a focus of intense research and product development. Hysteroscopic surgery has not had the same focus, secondary to a lack of reports of intraperitoneal dissemination resulting in clinically relevant pathology. Case: A 43-year-old female presented for hysterectomy secondary to symptomatic uterine fibroids. Her history was notable for an initial diagnostic laparoscopy with no pelvic abnormalities noted. This was followed by a hysteroscopic mechanical morcellation of a leiomyoma. At the time of her hysterectomy, she was noted to have disseminated peritoneal leiomyomatosis. Results: Pathology from the patient's resection of peritoneal implants showed diffuse peritoneal leiomyomatosis. Conclusions: Hysteroscopic mechanical morcellation of symptomatic fibroids can cause intraperitoneal spillage of intrauterine contents, which could result in intra-abdominal pathology. Further research is needed on this topic.