Laparoscopic Management of Disseminated Peritoneal Leiomyomatosis in a Patient Without a History of Myomectomy
Disseminated peritoneal leiomyomatosis (DPL) is a rare condition characterized by multiple peritoneal and subperitoneal nodules composed of smooth muscle cells. Although it has been associated with iatrogenic dissemination following uncontained power morcellation, it may also arise spontaneously. A 46-year-old G1P1 woman with no history of prior myomectomy or morcellation presented with lower abdominal pain and urinary symptoms. Pelvic magnetic resonance imaging (MRI) revealed a lobulated leiomyomatous uterus. She elected to undergo total laparoscopic hysterectomy. Intraoperatively, multiple nodules were unexpectedly identified on the omentum, pelvic peritoneum, and intestinal serosa. Total laparoscopic hysterectomy with bilateral salpingectomy, complete omentectomy, and pelvic peritonectomy was performed. Given the absence of a preoperative diagnosis and prior discussion of risks, a deliberate decision was made to leave the intestinal serosal nodules in situ. The uterus was extracted via contained (in-bag) power morcellation. Histopathological analysis confirmed leiomyoma without atypia. The patient had an uneventful recovery and was discharged within 24 hours. Following incomplete resection, a management plan with periodic imaging surveillance was adopted. One-year follow-up MRI demonstrated stable residual nodules with no features suggestive of malignancy. This report highlights that DPL can occur in patients without a history of morcellation and that preoperative diagnosis remains challenging. Laparoscopy appears to be an effective approach for both diagnostic confirmation and staged management. Decisions regarding extensive resection should consider surgical risk, the high recurrence rate, and the relatively low risk of malignant transformation. Contained power morcellation remains an important preventive strategy.