Puerperal spontaneous prolapse of large pedunculated uterine submucosal myoma after full-term vaginal delivery

F Chen,H Duan,J Cheng,Y Guo

doi:10.12891/ceog4265.2019

Abstract

Complications of submucosal myomas during pregnancy are rare and can be divided into those occurring during pregnancy, at delivery, and in the puerperium. The authors present two similar cases of unusual complication of submucosal uterine myoma in the puerperium. The two patients were admitted to this department for protruding vaginal mass after full-term vaginal delivery. Each experienced sudden severe abdominal pain, and felt a large vaginal mass after defecation or coughing. Combining gynecological examination and MRI, the authors accurately diagnosed the cases as spontaneous prolapse of large pedunculated uterine submucosal myoma. After anti-infective therapy, the 45-year-old woman underwent total laparoscopic hysterectomy; the second case, a 31-year-old woman was treated by a conservative surgical approach, including partial vaginal myomectomy and elective hysteroscopic myomectomy. This is the first report describing spontaneous prolapse of pedunculated uterine submucosal myoma in the puerperium after full-term vaginal delivery, and MRI played a key role in the diagnosis and treatment.

Highlights

Uterine myoma is the most common benign tumor of the female genital tract
Uterine myoma is associated with numerous pregnancy complications, including premature delivery, placental abruption, abnormal fetal position, and postpartum hemorrhage [2, 3]
Patients have even received hysterectomy for severe postpartum hemorrhage caused by submucosal uterine leiomyoma to avoid a life-threatening condition [4]

Summary

Introduction

Uterine myoma is the most common benign tumor of the female genital tract. A prospective study found myoma prevalence during pregnancy to be around 10.7% [1]. The authors present two cases of large pedunculated uterine submucosal myoma with local infection that spontaneously prolapsed into the vaginal cavity after full-term vaginal delivery. The patient had sudden lower abdominal pain without fever or nausea and vomiting; lochia amounts increased to menstrual blood loss volume. Fourteen days after abdominal pain onset, she felt a perineal mass which hardly regressed after stool When she arrived to the present department, gynecologic examination revealed the presence of a large vaginal mass measuring 6 cm in diameter, covered with pus moss and protruding from the cervix. MRI showed the same results as the above case, except that the mass was connected to the anterior wall of the uterine cavity and larger (Figure 4) Based on these data and the experience form the above patient, the lesion was diagnosed as submucosal uterine fibroid associated with infection.

Findings

Discussion

Conclusion