Pseudo-Meigs syndrome owing to a retained fibroid following total laparoscopic hysterectomy for multiple leiomyomas: A case report and review of the literature.
| Title: | Pseudo-Meigs syndrome owing to a retained fibroid following total laparoscopic hysterectomy for multiple leiomyomas: A case report and review of the literature. |
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| Authors: | Atilgan AE; Department of Urogynecology, Istanbul Medipol University Faculty of Medicine, Istanbul, Türkiye.; Dilmac AE; Department of Obstetrics and Gynecology, Aksaray Training and Research Hospital, Konya, Türkiye.; Akcaoglu T; Department of Urogynecology, Istanbul Medipol University Faculty of Medicine, Istanbul, Türkiye.; Department of Plastic and Reconstructive Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA. |
| Source: | International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics [Int J Gynaecol Obstet] 2026 Feb; Vol. 172 (2), pp. 845-849. Date of Electronic Publication: 2025 Aug 14. |
| Publication Type: | Journal Article; Case Reports; Review |
| Language: | English |
| Journal Info: | Publisher: Wiley Country of Publication: United States NLM ID: 0210174 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-3479 (Electronic) Linking ISSN: 00207292 NLM ISO Abbreviation: Int J Gynaecol Obstet Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2017- : Malden, MA : Wiley; Original Publication: [New York, NY] Hoeber Medical Division, Harper & Row, [c1969- |
| MeSH Terms: | Leiomyoma*/surgery ; Leiomyoma*/pathology ; Leiomyoma*/complications ; Uterine Neoplasms*/surgery ; Uterine Neoplasms*/pathology ; Hysterectomy*/adverse effects ; Hysterectomy*/methods ; Ascites*/etiology ; Meigs Syndrome*/etiology ; Meigs Syndrome*/diagnosis; Laparoscopy/adverse effects ; Menorrhagia/etiology ; Humans ; Female ; Adult |
| Abstract: | Total laparoscopic hysterectomy (TLH) is the most common gynecologic procedure for fibroids. However, massive serous ascites has not yet been reported. For this reason, the management of ascites is challenging because it is an unexpected situation. We present the case of a 42-year-old woman complaining of menorrhagia who was diagnosed with multiple leiomyomas on ultrasound examination. No abnormal findings were observed in the endometrium or ovaries. TLH and bilateral salpingectomy were performed. Specimens were extracted via vaginal morcellation using a scalpel. No intraoperative complications were observed. The final pathologic examination of the uterus, which contained 25 fibroids and tubes, was benign. However, serous ascites began to enter the drain on the first day. The volume of the ascites was approximately 9000 mL over 3 days. There were no abnormalities in vital signs, liver test results, or serum albumin, electrolyte, or hemoglobin levels. Radiologic images excluded bowel and urinary tract injuries. However, an intra-abdominal mass measuring 26 × 33 × 44 mm was detected on magnetic resonance imaging. Diagnostic laparoscopy revealed a myoma between the bowel loops, which was removed by placing it in an endobag. Thereafter, the ascites spontaneously resolved. Ascitic fluid is generally observed in gynecologic cancers. The basic treatment principles include close monitoring of vital signs, appropriate replacement of fluid deficits, drainage, and mobilization. Furthermore, treatment based on the etiopathology is crucial. In cases of multiple myomas, when extracting the uterus vaginally, a pedunculated myoma may break off or be missed in the abdomen. Leiomyomas have oncotic properties and can induce fluid flow from the intravascular to the peritoneal space. Rapid resolution of ascites after myoma removal indicates pseudo-Meigs syndrome.; (© 2025 International Federation of Gynecology and Obstetrics.) |
| References: | Krishnan CS, Grant PT, Robertson G, Hacker NF. Lymphatic ascites following lymphadenectomy for gynecological malignancy. Int J Gynecol Cancer. 2001;11:392‐396.; Frey MK, Ward NM, Caputo TA, Taylor J, Woeley Jr MJ, Slomovitz BM. Lymphatic ascites following pelvic and paraaortic lymphadenectomy procedures for gynecologic malignancies. Gynecol Oncol. 2012;125:48‐53.; Browse NL, Wilson NM, Russo F, Al‐Hassan H, Allen DR. Aetiology and treatment of chylous ascites. Br J Surg. 1992;79:1145‐1150.; Bhardwaj R, Vaziri H, Gautam A, Ballesteros E, Karimeddini D, Wu GY. Chylous ascites: a review of pathogenesis, diagnosis and treatment. J Clin Transl Hepatol. 2018;6:105‐113.; Chen L, Lin L, Li L, et al. Lymphatic leakage after pelvic lymphadenectomy for cervical cancer: a retrospective case‐control study. BMC Cancer. 2021;21(1):1242.; Ng ZQ, Han M, Beh HN, Keelan S. Chylous ascites in colorectal surgery: a systematic review. World J Gastrointest Surg. 2021;13(6):585‐596.; Hidalgo JE, Ramirez A, Patel S, et al. Chyloperitoneum after laparoscopic roux‐en‐Y gastric bypass (LRYGB). Obes Surg. 2010;20:257‐260.; Tan N, Jin KY, Yang XR, Li CF, Yao J, Zheng H. A case of death of patient with ovarian fibroma combined with Meigs syndrome and literature review. Diagn Pathol. 2022;17(1):83.; Saha S, Robertson M. Meigs' and Pseudo‐Meigs' syndrome. Australas J Ultrasound Med. 2012;15:29‐31.; Bowler T, Thomson M, Dasaraju S. Pseudo‐Meigs syndrome: a rare cause of abdominal ascites in a patient with an ovarian mass. BMJ Case Rep. 2025;18(4):e263547.; Roecker ZA, Young MR, Han C. Rapidly progressing ascites in a pregnancy with a massive fibroid: a case report and review of pseudo‐Meigs syndrome. Int J Gynaecol Obstet. 2024;167(1):128‐131.; Pauls M, MacKenzie H, Ramjeesingh R. Hydropic leiomyoma presenting as a rare condition of pseudo‐Meigs syndrome: literature review and a case of a pseudo‐Meigs syndrome mimicking ovarian carcinoma with elevated CA125. BMJ Case Rep. 2019;12(1):bcr‐2018‐226454.; Myhre‐Jensen O. A consecutive 7‐year series of 1331 benign soft tissue tumours. Clinicopathologic data. Comparison with sarcomas. Acta Orthop Scand. 1981;52(3):287‐293.; Zou L, Lou J, Huang H, Xu L. Pseudo‐Meigs syndrome caused by a rapidly enlarging hydropic leiomyoma with elevated CA125 levels mimicking ovarian malignancy: a case report and literature review. BMC Womens Health. 2024;24(1):445.; Viva W, Juhi D, Kristin A, et al. Massive uterine fibroid: a diagnostic dilemma: a case report and review of the literature. J Med Case Reports. 2021;15(1):344.; Van der Meulen JF, Pijnenborg JM, Boomsma CM, Verberg MF, Geomini PM, Bongers MY. Parasitic myoma after laparoscopic morcellation: a systematic review of the literature. BJOG. 2016;123(1):69‐75.; Rochling FA, Zetterman RK. Management of Ascites. Drugs. 2009;69:1739‐1760.; Kalayci TO et al. A giant subserosal uterine leiomyoma mimicking an abdominal mass: multimodal imaging data. Acta Med Iran. 2015;53(4):246‐249.; Frühauf F, Burgetová A, Lambert L, Němejcová K, Mára M, Fischerová D. Preoperative discrimination between uterine myomas and sarcomas. Cesk Gynekol. 2024;89(4):319‐328. doi:10.48095/cccg2024319.; Hong DG, Kim BS, Lee YS, Park IS, Cho YL. A case of massive serous ascites following radical hysterectomy with bilateral pelvic lymphadenectomy for cervical adenocarcinoma stage IB2. Korean J Gynecol Oncol. 2008;19(1):93‐98.; Pieper CC MD. Back to the future II—A comprehensive update on the rapidly evolving field of lymphatic imaging and interventions. Investig Radiol. 2023;58(8):610‐640.; Hattori Y, Yamashita S, Furuse K, Nakatsukasa S, Iida T. Lymphatic‐venous anastomosis for the treatment of refractory lymphatic ascites following radiation therapy: a case report. Microsurgery. 2022;42(4):376‐380.; Higami S, Tanaka Y, Maeda D, Yukimoto H, Ishii T, Shiki Y. Intranodal lymphangiography under microsurgery for refractory lymphatic ascites after pelvic lymphadenectomy. Gynecol Oncol Rep. 2024;52:101346. doi:10.1016/j.gore.2024.101346.; Fanali G, Di Masi A, Trezza V, Marino M, Fasano M, Ascenzi P. Human serum albumin: from bench to bedside. Mol Asp Med. 2012;33:209‐290. doi:10.1016/j.mam.2011.12.002.; Pompili E, Zaccherini G, Baldassarre M, Iannone G, Caraceni P. Albumin administration in internal medicine: a journey between effectiveness and futility. Eur J Intern Med. 2023;117:28‐37. doi:10.1016/j.ejim.2023.07.003.; Wagenpfeil J, Hoß K, Henkel A, et al. Interventional treatment of refractory non‐traumatic chylous effusions in patients with lymphoproliferative disorders. Clin Exp Med. 2024;24(1):63. doi:10.1007/s10238-024-01312-4.; Bernardi M, Angeli P, Claria J, et al. Albumin in decompensated cirrhosis: new concepts and perspectives. Gut. 2020;69:1127‐1138. doi:10.1136/gutjnl-2019-318843.; Peters T. All About Albumin: Biochemistry, Genetics, and Medical Applications. Academic Press; 1996. doi:10.1093/clinchem/43.10.2014a. |
| Contributed Indexing: | Keywords: ascites; leiomyoma; morcellation; pseudo‐Meigs syndrome; total laparoscopic hysterectomy |
| Entry Date(s): | Date Created: 20250814 Date Completed: 20260111 Latest Revision: 20260114 |
| Update Code: | 20260130 |
| DOI: | 10.1002/ijgo.70474 |
| PMID: | 40810624 |
| Database: | MEDLINE |
Journal Article; Case Reports; Review