Rare complications associated with uterine myomatosis: case reports

Czech version

Authors: Zuzana Čechová
Authors‘ workplace: Gynekologicko-porodnické oddělení, Nemocnice s poliklinikou Havířov, p. o., prim. MUDr. Petr Wiecek
Published in: Prakt Gyn 2013; 17(1): 79-85
Category: Gynecology and Obstetrics: Case Report

Overview

Purpose:
Providing evidence of possible serious and unusual complications associated with uterine myomatosis.

Methods:
3 case studies of different complications of uterine myomatosis.

Material and results:
The first case: a patient aged 42 hospitalized in a a state of shock for life threatening vaginal bleeding based on the arising submucous myoma. Severe anaemia identified on admission – Hgb 16 g/l, hemorrhagic shock demonstrated only by grade III, without manifestation of coagulation disorder. Following volume resuscitation an acute abdominal hysterectomy was performed. Further postoperative care was free of any complications. 8 erythrocytary concentrates transfusion units and 4 fresh frozen plasma transfusion units were given. The case study summarizes the basic management of hemorrhagic shock.

The second case:
a patient aged 34, nullipara, admitted for 5 weeks amenorrhea, positive HCG 1 880 IU/l and myomatous uterine corresponding in size to 20th week of pregnancy. Because of the monstrous myomatosis she was recommended termination of pregnancy. The standard solution, i.e. instrumental evacuation of the uterine cavity, was not successful due to the length and asymmetry of the uterine cavity. Given the patient's age and nulliparity, conservative approach was finally chosen – medicamental abortion using Methotrexate IM.

The third case:
a patient aged 45 without thromboembolism risk factors was admitted to the hospital for deep venous thrombosis due to iliac veins being oppressed by the myomatous uterus. Following anticoagulation treatment, insertion of a vena cava filter and subsequent hysterectomy was indicated. On the 5th day of hospitalization, however, a complete obturation was detected under the confluence of vena femoralis and vena saphaena magna and streaming thrombus was observed in the section between the inflow and thrombosis; therefore a vena cava filter was inserted without delay and afterwards abdominal simplex hysterectomy performed. Postoperative care already went on without complications.

Conclusion:
If left untreated, uterine myomatosis leads to serious and sometimes life threatening complications, whose solution requires interdisciplinary cooperation.

Key words:
fibroid complications – pharmacological abortion – thrombosis – uterine haemorrhage – uterine myomas – uterine myomatosis during pregnancy

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