The surgical management of prolapsed pedunculated submucous leiomyomas

Prolapsed pedunculated leiomyomas of the uterus can best be managed by simple vaginal myomectomy. It is safe, easily performed and generally requires no anesthesia. The risk of complications during and after a major abdominal surgical procedure in the face of infection and anemia is eliminated. Interval hysterectomy, if indicated, may be done four to six weeks after vaginal myomectomy without incurring the additional risk of increased operative morbidity. Additional surgical procedures are not indicated if the pelvic examination remains normal. When large leiomyomas are encountered, the pedicle may not be accessible. Confronted with such a situation and continued blood loss and sepsis, we elected in three patients to replace the tumor within the endometrial cavity and close the cervix. Immediate hysterectomy was then carried out. Blood replacementd antibiotic coverage were instituted in advance of any operative procedure. Other pathologic entities must be kept in mind as a source of uterine bleeding that may be found in association with pedunculated myomas.