Problem Statement Uterine leiomyoma are the most common tumour of the female reproductive tract but giant myomas (greater than 11.4kg) are exceedingly rare. They may be life threatening by causing pressure effects on the heart, lungs and adjacent organs. We present a case of a 53 year old woman with a massive uterine fibroid and discuss the multidisciplinary approach in management of this complex surgical patient. This case illustrates the importance of proper surgical management and peri-operative care in ensuring good outcome following excision. Method This is a case report studying the peri-operative management of a patient with a giant uterine leiomyoma. Case files and medical records of the patient were retrieved and analysed. Results: A 53 year old Malay woman with a background of schizophrenia presented with a large abdominal mass complicated by orthopnea and exertional dyspnea. Computed tomography scan revealed a 45.0 x 38.5 centimeter lobulated abdominopelvic mass suggestive of a fibroid with gross ascites. Prior to surgery, she was extensively worked up for potential complications of the mass with a lung function test and an echocardiogram. She also had a transabdominal ascitic drain inserted for temporary relief of abdominal distension. She successfully underwent a total abdominal hysterectomy bilateral salpingo-oophorectomy with frozen section by the gynaecology surgeons and the remaining abdominal wall defect was reconstructed by the plastic surgery team. The excised specimen weighed 27.8kilograms which included a benign subserosal leiomyoma measuring 64 x 50.5 x 15centimeters. Intra-operative blood loss was 7 litres, requiring activation of the National Massive Transfusion Protocol. Post-operatively, she was closely monitored in the Intensive Care Unit for management of haemorrhagic shock and coagulopathy. She made good recovery and was discharged on post-operative day 7. Conclusion Surgical excision of giant uterine leiomyoma is not only technically challenging, but also carries a high rate of morbidity and mortality given the risks of massive haemorrhage and postoperative complications. We explore the use of the National Massive Transfusion Protocol for the management of severe blood loss. This case illustrates the pivotal role of multidisciplinary care in the management of complicated surgical patients and the need for comprehensive pre-operative assessment, optimal intra-operative management and careful post-operative care.
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