Shabbir Hussain, Khalid Mahmood, Iqbal Muhammad.
Leiomyoma of Transverse Colon Presenting as Pelvic Mass.
Pak Armed Forces Med J Jan ;51(1):55-7.

A 44 years old, male patient, reported to the surgical outdoor of Combined Military Hospital, Bahawalpur with history of pain in the hypogastrium of 2 years duration. The pain was dull and localized, getting aggravated by ingestion of food and getting relieved by defecation. Pain used to persist if defecation was delayed. For the last 8 months, he noticed a gradually increasing painful swelling in the pelvis, which persisted even after micturation and defecation. There was no history of altered bowel habits, vomiting, malena, haematemesis, or weight loss. During this period he had symptomatic treatment from his village quack, which at times resulted in temporary symptomatic relief.

His clinical examination revealed a weak build male; with pulse of 80/min, BP was 130/90 mm Hg. There was no cervical or inguinal lymphadenopathy. Abdominal examination revealed a 10 x 8 x 7 cms intra abdominal mass, which was firm, nontender, not moving with respiration, in the hypogastrium. Rest of the abdominal examination was unremarkable.

Laboratory investigations revealed Haemoglobin of 10.4 grams/dl. Blood glucose, urea electrolytes, creatinine and LFTs were within normal limits. U/S Scan of the abdomen revealed a 10x8.3x7 cm mass with mixed echogenecity and areas of speckled calcification, in the pelvic area behind the urinary bladder. Long axis of the mass was along the long axis of the rectum. Liver, spleen, kidneys, gall bladder, CBD, pancreas and prostate were normal. There was no paraaortic lymphadenopathy. Barium Enema examination revealed normal anatomical configuration, outline, mucosal and haustral pattern. No filling defect, stricture, or evidence of ulceration was seen radiologically. However loops of sigmoid colon were displaced downward due to pelvic mass. FNA of the mass was carried out under U/S guidance which revealed a hypocellular aspirate consisting of a few scattered fragments and isolated spindle shaped cells, of benign morphology. The background was haemorrhagic. There was no evidence of epithelial primary or metastatic tumour, sarcoma or lymphoma. An opinion of "suspicious for a smooth muscle tumour" was given and an advice for laparotomy and open biopsy was rendered for definite diagnosis. Patient was prepared for laparotomy after confirming 3 units of cross-matched blood.

Under general anesthesia and under aseptic conditions, abdomen was opened by infra umbilical midline incision. A 10x8x7 cms mass was found in the pelvis, arising from the transverse colon, about 10cms from hepatic flexure. Mass was adherent with loops of small intestine and sigmoid colon. After separating the adhesions, mass alongwith 07 cms of transverse colon on either side was resected and colonic continuity was restored by end-to-end anastomosis in two layers. Postoperatively the patient made an uneventful recovery. Patient was discharged on 10th post operative day with advise of regular follow up in outdoor. Histopathology of the growth confirmed it to be leiomyoma arising from transverse colon.

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