Bile Leak Refilling an Intrahepatic Biloma Managed with AMPLATZER Vascular Plug

Abstract

tumor sizes. Although hysterectomy remains the gold-standard treatment for uterine myomas, it is an unacceptable treatment option for patients who want their uterus to be preserved. For this group of patients, several treatment options exist, including myomectomy and uterine artery embolization. As myomectomy is an invasive surgical procedure, it is associated with the risks of intraoperative blood loss, emergency hysterectomy, cesarean section, and uterine rupture during pregnancy after treatment (3). In patients with submucosal myomas treated with uterine artery embolization, complications of infection and pain during vaginal myoma expulsion have been reported (4). Currently, in cases of submucosal myomas, transvaginal resection with resectoscopy is a good option, but the indications for this technique are limited to small myomas with penetration into the uterine cavity greater than 50% (3). MRgFUS treatment of uterine myomas has clearly demonstrated myoma shrinkage and significant symptom reduction, with only minor complications such as skin burn and nerve heating, which have shown complete improvement with conservative therapy (1). A report of vaginal expulsion of a very large necrotic submucosal myoma after MRgFUS describes removal by hysteroscopy without injury to the uterine endometrium (5). Here we have described successful MRgFUS treatment of an intracavitary submucosal myoma by selective targeting of the stalk connecting it to the uterus, and the resulting disconnection of the myoma, without the need for any additional invasive procedures and without associated complications of infection, pain, or excessive vaginal bleeding during spontaneous expulsion of the myoma. In addition, during the 3-month follow-up period after MRgFUS treatment, the patient experienced decreased menstrual bleeding. In cases of very large submucosal myomas, there may be complications related to the expulsion of the large mass through the vagina, for which a subsequent hysteroscopic resection would be required. The present case suggests the potential exploratory use of MRgFUS for the disconnection of an intracavitary submucosal myoma to the uterine cavity, but further work is required to provide additional knowledge of possible outcomes or complications.