Acute hysterectomy for huge submucous leiomyoma prolaps

Czech version

Authors: P. Zielina; R. Schreier
Authors‘ workplace: Gynekologicko-porodnické oddělení nemocnice Třinec, primář MUDr. R. Schreier
Published in: Ceska Gynekol 2009; 74(5): 389-392

Overview

Objective:
To present a case of huge submucous leiomyoma prolaps to the vagina with severe haemorrhage and its management and to analyse current articles with this rare complication.

Design:
A case report, review article.

Setting:
Department of Gynecology and Obstetrics Třinec Hospital.

Results:
A case report of huge submucous leiomyoma prolaps in 49-year-old woman. The patient presented at our department with sudden onset of profuse vaginal bleeding. The vaginal and utrasound examination was performed with diagnosis of huge submucous leiomyoma obturating upper third of the vagina. The cervix was not palpable, rised up. While manipulating with the leiomyoma the bleeding exceeded. The patient agreed with abdominal hysterectomy without adnexectomy. Then the patinent colapsed and the operation was performed immediately, taking care of changed anatomy – the line between the vaginal wall and the uterus was almost invisible caused by „non-existing cervix“ and the uterus was partialy inverted into the vagina. The haemoglobin level falled from 124 g/l to 95 g/l with no need of tranfusion. The patient quickly recovered and was dimised the sixth day after the operation.

Conclusion:
Uterine myomas in their submucous localisation may protrude through the cervix into the vagina and cause rare but very serious complications - profuse vaginal bleeding and non-puerperal inversion of the uterus, and thus need very urgent management.

Key words:
submucous leiomyoma, prolaps, non-puerperal inversion of the uterus.

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