Pseudo-Meigs syndrome owing to a retained fibroid following total laparoscopic hysterectomy for multiple leiomyomas: A case report and review of the literature

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 x 33 x 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.