Laparoscopic hysterectomy...

A 42-year-old obese woman was referred to a surgical department to treat a large fibromatous uterus. She had been experiencing pelvic pressure, abdominal distension, and severe shortness of breath for several months. Her laboratory tests indicated polycythemia, including hemoglobin (Hb) at 19.2 g/dL and hematocrit (Hct) at 59.7%. An arterial blood gas analysis showed her oxygen pressure (pO2) was 81.5 mmHg. Computed tomography of her abdomen confirmed a giant fibromatous uterus measuring 28.2 cm × 17 cm × 25 cm (Figure 1). She underwent low molecular weight heparin and phlebotomy twice before surgery to decrease the risk of blood clots. A laparoscopic hysterectomy was performed, and the uterus weighed 5400 g. The pathology report confirmed a diagnosis of leiomyoma, and there were no complications during or after the surgery. On the first day after surgery, her Hb and Hct levels normalized to 13.3 g/dL and 41.7%, respectively, and an arterial blood gas analysis showed a pO2 of 144.7 mmHg. These results suggested that the patient had myomatous erythrocytosis syndrome (MES), and she was discharged from the hospital in good condition with no symptoms on the second day after surgery.