Abstract
Background: Submucosal fibroids account for approximately 15 - 20 percent of total fibroids. Rarely, they prolapse. Common size is 2 - 6 cm, because larger fibroids are unlikely to fit through the cervix. Larger fibroids are associated with significant bleeding and pose a surgical challenge. Case Presentation: We present a 38-year-old woman nulliparous with an intravaginal pedunculated fibroid, 12 cm in diameter. She presented with metrorrhagia and an intense malodorous vaginal discharge, irresponsive to oral therapy. The patient had a history of resectoscopic fibroid enucleation, 7 months earlier, followed by insertion of an (intra-uterine device) IUD. There was no uterine prolapse. Management involved bilateral uterine artery embolization, followed by hysteroscopic excision with rigid resectoscope. The fibroid was “delivered” transvaginally intact. The uterus was preserved. The IUD was partly buried within the mass. Blood loss was negligible. Patient recovery was quick and uneventful. At 6-months follow up, pelvic anatomy has been restored. Conclusion: Large pedunculated fibroids are very rare. Embolization of uterine arteries has proven a valuable tool in challenging gynecologic operations. In our case, not only it prevented massive bleeding during excision, but also allowed a fertility-sparing minimally invasive management.
Highlights
In literature, there are only a small number of reports for pedunculated submucosal fibroids [1] [2] [3] [4]
Submucosal fibroids account for approximately 15 - 20 percent of total fibroids
Case Presentation: We present a 38-year-old woman nulliparous with an intravaginal pedunculated fibroid, 12 cm in diameter
Summary
There are only a small number of reports for pedunculated submucosal fibroids [1] [2] [3] [4]. Submucosal fibroids account for approximately 15 -. The proportion of submucosal leiomyomas that prolapse through the cervix is uncertain. An estimate of about 2% of submucosal leiomyomas is reported. Larger fibroids are unlikely to prolapse through the cervix. The most common clinical presentation is severe vaginal bleeding [4]. Prolapsed leiomyomas are typically removed via vaginal myomectomy, when significantly large, they pose a surgical challenge. Most cases in literature were treated with either scheduled abdominal total hysterectomy, or emergency abdominal hysterectomy due to uncontrollable bleeding after a vaginal approach. The preoperative uterine artery embolization (UAE) is a safe procedure that becomes more and more popular in complicated gynecologic surgery
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