33 year old mother of two children, presented herself with multiple myomata reaching the xiphistetnum with a main complaint of pressure symptoms and difficult breathing. She had a pfannenstiel scar for her two cesarean sections; last one was two years earlier. Laparotomy through pfannenstiel incision and muscle cutting was carried out. There was a 40x 40cm cauliflower broad ligament fibroid with the uterus just sitting on it. Successful myomectomy was carried out.

1. Galal Lotfi, MD. MRCOG
Prof. Obstetrics & Gynecology
Suez Canal University
Egypt

2. The patient
33 year old mother of two children, presented
herself with multiple myomata reaching the
xiphisternum with a main complaint of pressure
symptoms and difficult breathing. She had a
pfannenstiel scar for her two cesarean sections;
last one was two years earlier. Laparotomy through
pfannenstiel incision and muscle cutting was
carried out. There was a 40x 40cm cauliflower
broad ligament fibroid with the uterus just sitting on
it. Successful myomectomy was carried out.

3. Ovary
Uterus
Tube
Part of the
Mass
The other half of the mass was
still incarcerated in the pouch of
Douglas, Not Out Yet

6. Almost half
of the broad
ligament
myoma is
now out but
still the other
half was
incarcerated
in the pouch
of Douglas

8. The there half in
now out
Uterus

9. Uteru
Uterus

15. Outcome
• Myoma was removed, 40x40 Cm, 8.5Kg weight
• Uterus, both ovaries and tubes were left intact
• Post operative was uneventful