Surgical Techniques for a Parasitic Myoma Fed by the Mesentery: A Case Report and Technical Discussion.

Parasitic myoma (PM) is a rare form of leiomyoma that detaches from the uterus and acquires a blood supply from other organs. While often iatrogenic following power morcellation, primary spontaneous PM can occur. We present a surgical case of a PM fed by the mesentery, likely resulting from inflammatory adhesions following a previous small bowel ileus. A 33-year-old nulliparous woman with no history of prior surgeries underwent laparoscopic myomectomy for a suspected subserosal myoma. Intraoperatively, we encountered a PM with a significant vascular supply extending from the mesentery to the uterine wall. The tumor was firmly adherent to the gastrointestinal tract. We examined the technical management of high-risk vascular adhesions. Key maneuvers included: (1) injection of vasopressin strictly on the uterine side of the attachment to avoid compromising mesenteric blood flow; (2) precise identification of the dissection plane; and (3) meticulous dissection alternating between monopolar excision and blunt separation to preserve the bowel integrity. The tumor was successfully detached, and the feeding vessels were coagulated. A containment bag was used during morcellation to prevent iatrogenic seeding. Operative time was 145 minutes with no bowel injury. This case highlights that PM should be considered even in patients without prior gynecologic surgery if there is a history of intra-abdominal inflammation. Careful identification of dissection planes and management of feeding vessels are critical for safe laparoscopic management.