Selecting the best surgical approach in various cases of prolapsed pedunculated submucosal fibroids: A case series
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Published on: January 17, 2019
Gita Nurul Hidayah1, Achmad Kemal Harzif2, Astri Noviani3
1Urogynecology, Reconstructive Pelvic and Aesthetic Surgery Division, Obstetrics and Gynaecology (O & G) Department, dr. Cipto Mangunkusumo Hospital Jakarta-Faculty of Medicine Universitas Indonesia (FMUI), Indonesia.
Introduction:
The pedunculated fibroid is classically managed through vaginal myomectomy. However, vaginal myomectomy cannot be safely and easily performed in all cases. We reviewed three cases of prolapsed pedunculated submucosal fibroids, each with a specific surgical difficulty.
Presentation Of Cases:
The first case had a prolapsed pedunculated uterine fibroid in pregnancy and underwent fibroid extirpation during an emergency cesarean section through the lower uterine segment incision. The second case was a nulliparous woman with recurrent abnormal uterine bleeding due to a giant prolapsed pedunculated uterine fibroid who underwent laparotomy fibroid extirpation through posterior colpotomy, preserving the uterus. The third case had a prolapsed pedunculated uterine fibroid in perimenopause with multiple fibroids and underwent fibroid stalk excision through an isthmic incision to facilitate a safe laparotomy hysterectomy procedure.
Discussion:
Vaginal removal has become the standard surgical method for prolapsed pedunculated submucous fibroids. However, some possible consequences of vaginal myomectomy include severe stalk bleeding, infection, and uterus inversion induced by excessive traction. Therefore, specific approaches are needed in some circumstances.
Conclusion:
Customised surgical approaches provided safe and efficient access to the prolapsed pedunculated fibroid stalk during myomectomy or hysterectomy.
