Open Access Case report

Large twisted ovarian fibroma associated with Meigs’ syndrome, abdominal pain and severe anemia treated by laparoscopic surgery

Antonio Macciò1*, Clelia Madeddu2, Paraskevas Kotsonis3, Michele Pietrangeli1 and Anna Maria Paoletti4

Author Affiliations

1 Department of Gynecologic Oncology, Businco Hospital, Regional Referral Center for Cancer Disease, via Edward Jenner, Cagliari 09121, Italy

2 Department of Medical Science “Mario Aresu”, University of Cagliari, Cagliari, Italy

3 Department of Obstetrics and Gynecology, Sirai Hospital, Carbonia, Italy

4 Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy

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BMC Surgery 2014, 14:38  doi:10.1186/1471-2482-14-38

Published: 24 June 2014

Abstract

Background

The Meigs' syndrome is a rare but well-known syndrome defined as the triad of benign solid ovarian tumor, ascites, and pleural effusion. Meigs' syndrome always requires surgical treatment. However, the optimal approach for its management has not been sufficiently investigated.

Case presentation

We report a patient with a large twisted ovarian fibroma associated with Meigs’ syndrome, abdominal pain and severe hemolytic anemia that was treated by laparoscopic surgery. This case highlights the difficulties that may be encountered in the management of patients with Meigs’ syndrome, including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the medical and surgical approach and the adverse impact that Meigs’ syndrome can have on the patient’s condition, especially if it is associated with acute pain and severe anemia. Considering the patient’s serious clinical condition and assuming that she had Meigs' syndrome with a twisted large ovarian mass and possible hemolytic anemia, we first concentrated on effective medical management of our patient and chose the most appropriate surgical treatment after laparoscopic examination. The main aim of our initial approach was preoperative management of the anemia. Blood transfusions and glucocorticoid therapy resulted in stabilization of the hemoglobin level and normalization of the bilirubin levels, which confirmed the appropriateness of this approach. Laparoscopic surgery 4 days after admission enabled definitive diagnosis of the tumor, confirmed torsion and removed the bulky ovarian fibroma, resulting in timely resolution of symptoms, short hospitalization, relatively low morbidity and a rapid return to her social and professional life.

Conclusions

This case highlights the difficulties that may be encountered in the management of patients with Meigs' syndrome, including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the medical and surgical approach, and the adverse impact that Meigs' syndrome can have on the patient's condition, especially if it is associated with acute pain and severe anemia. The present case suggests that laparoscopic surgery for potentially large malignant tumors is feasible and safe, but requires an appropriate medical and gynecological oncology expertise.

Keywords:
Meigs’ syndrome; Laparoscopy; Hemolytic anemia; Ovarian fibroma