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From question on page 386

Figure 1 shows a water soluble contrast enema, which revealed obstruction at the rectosigmoid, apparently caused by an extrinsic pelvic mass.

An emergency laparotomy for large bowel obstruction was carried out. At operation she was found to have a dilated small and large bowel with a cut off at the rectosigmoid. The cause of the obstruction was a hugely enlarged fibroid uterus which was incarcerated in the pelvis. A subtotal hysterectomy was performed to relieve the obstruction. The compressed large bowel was found to be healthy and did not necessitate resection. She eventually made a complete recovery, enjoying normal bowel function.

Histology confirmed a hugely enlarged uterus distorted by a single 11×9×7.5 cm leiomyoma with no evidence of dysplasia or malignancy.

Gynaecological disease and its treatment is a relatively common cause of bowel obstruction. The commonest cause is gynaecological malignancy, particularly that of the ovaries and complications of treatment such as adhesions and radiotherapy.

Leiomyomas or fibroids are benign smooth muscle tumours of the uterine myometrium and are a common condition in women especially over the age of 40 years. Small leiomyomas are present in more than 20% of women over the age of 40 years and usually remain asymptomatic. However, bowel obstruction secondary to benign uterine leiomyomas may occur, albeit rarely.

This should be considered early in female patients and if rapid sustained resolution of the clinical features of obstruction does not occur, the condition should be treated aggressively with surgical intervention.

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