Delayed presentation of giant uterine fibroids in a Nigerian private specialist health facility

Abstract

Giant uterine fibroids (leiomyoma or myomas) which are fibroid masses greater than 11.4 kg are very rare. Although benign in nature, it may present with symptoms that impact negatively on the quality of life and health of the patient and impose greater management challenges. We present two cases of giant uterine fibroids that were successfully managed in a private specialist hospital without complications. Case 1 was a 38-year-old nulliparous Nigerian woman who presented with giant uterine fibroids (11.6 kg) who initially had delay of surgery due to fear that after surgery she may lose her “womb” or not be able to conceive after the operation. Later, she had successful open abdominal myomectomy, with the use of Foley catheters as improvise equipment for tourniquet and abdominal drain. Anti-adhesion agent was not used. Case 2 was a 47-year-old nulliparous Nigerian teacher with giant fibroids (13.2 kg) who also initially had delayed surgery due to fear that fibroid surgery is a major operation that it may get complicated and she may die. Also, she was afraid that she may not have her womb in her next world if she gets reincarnated. She had total abdominal hysterectomy and bilateral salpingo-oophorectomy without complications. For both cases, pre-surgery leiomyosarcoma assessment with computed tomography scan or magnetic resonance imaging and anti-adhesion agent were not used due to very unaffordable high costs. These reports of giant uterine fibroids (leiomyoma or myomas) are very rare gynecological entity, and management can be successful despite overwhelming challenges in low-income countries. Cheaper, affordable and available alternatives (improvises) can be resorted to for tackling its challenges in low-income settings.