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Rare complications associated with uterine myomatosis: case reports


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


Sources

1. Abdul Ghaffar NA, Ismail MP, Nik Mahmood NM et al. Huge uterine fibroid in a postmenopausal woman associated with polycythaemia: a case report. Maturitas 2008; 60(2): 177–179.

2. American College of Obstetricians and Gynecologists Committee. Medical management of abortion. Obstet Gynecol 2005; 106(2): 413–425.

3. Blatný J, Cvachovec K, Černý V et al. Doporučený postup pro léčbu život ohrožujícího krvácení – mezioborové konsensuální stanovisko 2011. Dostupné z WWW: <http://www.csarim.cz/Public/csim/DP_ZOK_2011_fi nal_121211.pdf>.

4. Blatný J. Krvácení a jeho léčba – (nejen) hematologický problém. Interní Med 2009; 11(3): 120–122.

5. Cocchi MN, Kimlin E, Walsh M, Donnino MW. Identification and resuscitation of the trauma patient in shock. Emerg Med Clin N Am 2007; 25(3): 623–642.

6. Černý V et al. Zásady podpory koagulace u život ohrožujícího a neztišitelného krvácení. Anest intenziv med 2005; 16(6): 314- 315.

7. Dekel A, Rabinerson D, Dicker D et al. Thrombosis of the pelvic veins associated with a large myomatous uterus. Obstet Gynecol 1998; 92(4 Pt 2): 646–647.

8. Eddy VA, Morris JA jr, Cullinane DC. Hypothermia, coagulopathy, and acidosis. Surg Clin North Am 2000; 80(3): 845–854.

9. Evans P, Brunsell S. Uterine fibroid tumors: Diagnosis and treatment. Am Fam Physician 2007; 75(10): 1503–1508.

10. Hudeček R, Ivanová Z, Šmerdová M et al. Vliv aplikace GnRH analog na peroperační a postoperační výsledky myomektomie u žen v reprodukčním věku. Čes Gyn 2012; 77(2): 108–116.

11. Hurt KJ, Guile MW, Bienstock JL et al. The John Hopkins Manual of Gynecology and Obstetrics. 4th ed. Lippincott Williams & Wilkins, Wolters Kluwer business: Philadelphia 2011: 450–453.

12. Chandra BS, Nibedita C, Ramprasad D et al. Deep venous thrombosis associated with fibroid uterus in a woman complicated by diabetes, hypertension and hemiparesis. J Obstet Gynaecol India 2010; 60(3): 240–241.

13. Chong YS, Fong YF, Ng, SC. Deep vein thrombosis in patients with large uterine myomata. Obstet Gynecol, 1998, 92(4 Pt 2): 707.

14. Kolařík D, Halaška M, Feyereisl J. Repetitorium gynekologie. Maxdorf: Praha 2008: 751–760.

15. Krajčovičová R, Hudeček R. Vliv děložní myomatózy na reprodukční funkce. Prakt Gyn 2010; 14(4): 154–163.

16. Mára M, Holub Z. Děložní myomy – moderní diagnostika a léčba. Grada Publishing: Praha 2009. ISBN 987–80–247–1854–5.

17. Matchar DB, Myers ER, Barber MW et al. Management of uterine fibroids. Evidence Report 2001; 34(1): 12–17.

18. Narita F, Ohara N, Fukunaga K. Myomatous erythrocytosis syndrome. J Obstet Gynaecol 2003; 23(5): 577.

19. Nishikawa H, Ideishi M, Nishimura T et al. Deep venous thrombosis and pulmonary thromboembolism associated with a huge uterine myoma: a case report. Angiology 2000; 51(2): 161–166.

20. Ozeren M, Bilekli C, Aydemir V, Bozkaya H. Methotrexate and misoprostol used alone or in combination for early abortion. Contraception, 1999; 59(6): 389–394.

21. Parker WH. Etiology, symptomatology and diagnosis of uterine myomas. Fertil Steril 2007; 87(4): 725–736.

22. Phupong V, Tresukosol D, Taneepanichskul S et al. Unilateral deep vein thrombosis associated with a large myoma uteri. A case report. J Reprod Med 2001; 46(6): 618–620.

23. Roztočil A. Reflexe článku A regest for abortion. Moderní gyn por 2012; 21(1): 29–33.

24. Shapiro MJ, Gettinger A, Corwin H et al. Anemia and blood transfusion in trauma patients admitted to the intensive care unit. J Trauma 2003; 55(2): 269–274.

25. Silbernagl S, Lang F. Atlas patofyziologie. 2. ed. Georg Thieme Verlag KG: Stuttgart 2010: 32–98.

26. Stanko CM, Severson MA II, Molpus KL. Deep venous thrombosis associated with large leiomyomata uteri. J Reprod Med 2001; 46(4): 405–407.

27. Tanaka H, Umekawa T, Kikukawa T et al. Venous thromboembolic diseases associated with uterine myomas diagnosed before hysterectomy: a report of two cases. J Obstet Gynaecol Res 2002; 28(6): 300–303.

28. Vilos GA, Vilos EC, Abu-Rafea B, Hollet-Caines J. Transvaginal doppler-guided uterine artery occlusion for the treatment of symptomatic fibroids: Summary results from two pilot studies. J Obstet Gynaecol Can 2010; 32(2): 149–154.

29. Wiebe ER. Comparing abortion induced with methotrexate and misoprostol to methotrexate alone. Contraception 1999; 59(1): 7–10.

30. Mára M, Kubínová K, Horák P, Kužel D. Děložní myomy. Postgrad med 2013; 3: 247nn.

31. Dostupné z WWW: <http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/002041/human_med_001542.jsp&mid=WC0b01ac058001d124>.

32. Kubínová K. Ulipristal acetát: nový přípravek v léčbě děložních myomů. Prakt Gyn 2012; 16(2–4): 77–79.

33. Mára M, Horák P, Kubínová K. Ulipristal acetát. Remedia 2012; 22(5): 307–313.

34. Marret H, Fritel X, Ouldamer L et al. Therapeutic management of uterine fibroid tumors: updated French guidelines. Eur J Obstet Gynecol Reprod Biol 2012; 165(2): 156–164.

35. Donnez J, Tomaszewski J, Vázquez F et al. Ulipristal Acetate versus Leuprolide Acetate for Uterine Fibroids. N Engl J Med 2012; 366(5): 421–432.

36. Murphy AA, Kettel LM, Morales AJ et al. Regression of uterine leiomyomata in response to the antiprogesterone RU 486. J Clin Endocrinol Metab 1993; 76(2): 513–517.

37. Carbonell Esteve JL, Riverón AM, Cano M, et al. Mifepristone 2.5 mg versus 5 mg daily in the treatment of leiomyoma before surgery. Int J Womens Health 2012; 4: 75–84.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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2013 Issue 1

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