Abstract
Spontaneous vaginal expulsion is a really rare condition which without proper treatment may cause many lifethreatening complications. Therefore, we present the case of a young woman who was admitted to a gynecological ward because of the heavy menstrual bleeding, abdominal pain since 3 weeks, anemia and fever. The patient did not reveal any medical history. During the hospitalization spontaneous, vaginal expulsions of a purple-grey, stinking tissue were observed. Because of the unclear symptomatology and imprecise results of ultrasound scans, she was subjected to a detailed examination. The spontaneous, unusual vaginal expulsion of the uterine myomas was diagnosed. According to authors knowledge it is the first case study in unusually young women, which shows spontaneous expulsion of myomas without known reason. By this study, authors want to increase awareness of this disease process, present multiple diagnostic dilemmas which can delay diagnosis and show different ways of treatment.
Highlights
Myomas are benign tumors of the reproductive organ that originate in the smooth muscles of the uterine wall
One of the theories suggests that ischemia followed by necrosis of a myoma is a principal cause of the dead tissue expulsion
The whole process of the expulsion described in the study might bring to mind the sloughing off process of myomas after embolisation
Summary
Myomas are benign tumors of the reproductive organ that originate in the smooth muscles of the uterine wall. Because of the diagnosis uterine myomas, long lasting pain and bleeding the surgery was arranged to remove myomas. Few days after a purple-grey, flaccid, stinking tissue, which did not resemble a myoma, were excreted from the vagina, which postponed the planned surgery to broaden diagnosis. The patient was histopathologically diagnosed with myomas, the symptomatology was still unclear and continuous, abnormal vaginal discharge which did not approximate to prolapsed uterine myoma (crumbling tissues) was observed. A magnetic resonance imaging (MRI) was done to complete pre-operative diagnosis It showed the myoma (42 × 43 × 47 mm) in the anterior wall of the uterus protruding into its cavity (Figure 3). After 7 weeks of observation with the above-mentioned treatment, the vaginal discharge, bleeding and abdominal pain were absent, the temperature and C-reactive protein level normalized. The follow-up ultrasound after 4 months was unremarkable with no pathological lesions in the uterus
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