Preoperative Uterine Artery Embolization for Huge Prolapsed Pedunculated Submucosal Fibroid
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 6
Abstract
Uterine fibroids (myomas) are very common affecting more than 60% of women over the age of 45 years [1,2]. Although many fibroids are asymptomatic, some may cause exhausting symptoms including heavy menstrual bleeding and pelvic pain. Submucosal fibroids, in particular pedunculated fibroids prolapsed into the vagina, are associated with heavy uterine bleeding and subsequent heavy anemia. The management of prolapsed pedunculated fibroid is determined by the origin and thickness of the pedicle, size, and its location. Uterine artery embolization (UAE) is increasingly being applied as a minimally invasive treatment alternative to surgery for the reduction of uterine fibroid symptoms [3]. UAEinduced depletion of blood flow through the whole myometrium and endometrium may be a useful adjunct to surgery for massive fibroids to reduce intraoperative blood loss [4]. Case 1 A 50 year old woman, G3P3, had a 1-year history of intermittent vaginal bleeding and progressive anemia. Physical examination revealed an ellipse of semi-solid; smooth surfaced mass occupying the vaginal cavity and hemoglobin level was remarkably decreasing (1.2 g/dl). Transfusion therapy was started immediately and intravenous iron prescribed to optimize her hemodynamic state. MRI detected a vaginal heterogenous mass 10x15x11cm, with regular edges and a vascular pedicle (Figure 1a). The mass seemed to dilate cervix up to the uterine fundus. Consideration of the inability to reach the pedicle through the vagina and the heavy vascularization of the fibroid led to the surgical approach through abdominal. The patient was put off UAE to reduce the blood supply, within 24 hours, with a surgical excision of 70% of the fibroid vaginally and subsequent simple abdominal hysterectomy and bilateral salpingo-oophorectomy. A 53-year-old woman, G2P2 (2 cesarean sections), was referred to us complaining of significant vaginal discharge for 2 years. Pelvic examination detected an over man’s fist sized, well-circumscribed mass in the vagina. Laboratory examinations revealed hemoglobin of 4.5 g/dl. MRI detected a margin-free vaginal mass 8x9x13 cm, with a highly vascular pedicle (Figure 1b). The patient was submitted to transfusion therapy, UAE proceeding later with subsequent total abdominal hysterectomy with salpingo-oophorectomy within 48 hours.
Authors and Affiliations
Chinatsu Koiwai, Satoshi Ichigo, Hiroshi Takagi, Hiroyuki Kajikawa, Kazutoshi Matsunami, Atsushi Imai
Keywords
Related Articles
- EP ID EP573891
- DOI 10.26717/BJSTR.2017.01.000507
- Views 162
- Downloads 0
Evolution and Epidemiology of Antimicrobial Resistance: Staphylococcus aureus
Staphylococcus aureus is a potentially pathogenic bacterium that causes a wide range of diseases. These are causing different infections and resistance mechanism due to of its wide virulence factors. The increase in the...
Giant Cell-Rich Variant of Extraskeletal Osteosarcoma Above the Patella – A Rare Case Study and Review of the Literature
Background: The giant cell-rich variant of extraskeletal osteosarcoma is a rare subtype of osteosarcoma, occurring in the extremities of adults prevalently in their sixth decade of life. We report an exceptional giant ce...
Biomarkers and the Future of Pediatric Gastroenterology
Biomarker discovery in the field of pediatric gastroenterology is necessary so that clinicians can use objective, non-invasive ways to screen for a disease in its preclinical stage, measure disease severity or monitor re...
Exploratory Research Antimalarial Properties Alstonia Congensis - the Pilot Survey Results Conducted in Kenge, Province Kwango DRC
Malaria is Ravaging tropical countries. This disease is the third leading causes of death worldwide with two to three million victims per year Mainly in Africa. Currently, traditional medical knowledge is increasingly us...
An Alternative Therapy with Ozone to Avoid Antimicrobial Resistence (AMR) in Uterine Infections in Dairy Cattle
Antimicrobial resistance (AMR) is major problem in treatment of uterine infections in dairy animals. To suggest an alternative treatment, avoiding antibiotics, the effect of ozone as therapy against common bacterial uter...