A case of cervical uterine myoma treated with loop ligation and hysteroscopic resection

Abstract

Submucosal myomas often become pedunculated and pass through the cervix, resulting in episodes of major genital hemorrhage. We attempted the removal of prolapsed uterine myomas in an outpatient, using a loop ligator device (ENDOLOOP PDS II ETHICON ®). Here, we report our experience with successful removal of multiple transvaginal uterine myomas by ligation of the stem. A 52-year-old patient (gravida 3, para 2) presented with severe anemia secondary to hypermenorrhea. Colposcopic examination, transvaginal ultrasonography, and pelvic magnetic resonance imaging led to the diagnosis of a prolapsed uterine myoma. For personal reasons, the patient requested outpatient management and underwent treatment with loop ligation. Following ligation, the hypermenorrhea improved, without exacerbation of anemia or signs of infection. The submucosal myoma gradually receded due to the decreased blood flow caused by ligation. At 41 months after initial evaluation, myoma resection was performed using hysteroscopy. The uterine myoma was suspended by a thick stem; therefore, several ligation treatments were performed over an extended period. Ligation was aimed at cutting off the blood flow to the prolapsed uterine myoma. Even if blood flow could not be completely cut off, ligation was expected to decrease the uterine myoma size by decreasing blood flow.