Uterine Fibromyoma and Intravascular Thrombosis—Eight Cases

Abstract

Objectives: We present eight cases of vascular thrombosis of the pelvic vessels and deep venous thrombosis (DVT) of the lower limb, secondary to compression of the pelvic vessels by the uterine fibroid, managed over a span of twelve years from 2001 to 2013. We discuss the mean size of the leiomyoma, the prediliction for DVT of the left lower limb, the role of oral contraceptives when used in women with large fibroids, to increase the risk of DVT and present a brief literature review. Results: Age, the mean age of our patients was-41.12 yrs, range-18 yrs to 50 yrs. Parity and Menopausal Status: Seven were parous women. One was unmarried, nulligravid. Seven were premenopausal and one was postmenopausal. Vascular Thrombosis: In one it was arterial thrombosis and in seven it was venous thrombosis. DVT was on the left side in −6/8 -75%. Clinical Complaints: The presenting complaints were heavy menstrual bleeding in three, severe dysmenorrhoea and heavy bleeding in one, mass per abdomen in one, heavy menses and abdominal mass in one, no complaints apart from DVT in one. Uterine Enlargement: The size of the uterus was between 12 to 26 weeks. The mean size was 20 weeks. It was a single fibromyoma in six and multiple, two in two. Use of Oral Contraceptives: OC pills were used to control heavy menstrual bleeding in three cases-3/8, 37.5%. Discussion: The DVT was on the left side in six of our cases, 75% were on the left side in our series. Menstrual problems like heavy bleeding can be secondary to fibromyoma. Three of the eight-37.5%, women used OC pills to control menorrhagia. One developed DVT after one cycle of use of OC pills; the second developed arterial thrombosis of the pelvic vessels after four cycles of OC pill use; the third used OC pills for a longer period, on and off.

Menstrual Abnormalities and Gynaecological Problems in Women on Anticoagulant and Antiplatelet Therapy: Management Options

“…Fibromyoma was the cause of DVT in two of the cases [39]. Anticoagulants could be stopped after hysterectomy, after recanalisation of the vessels.…”

“…In this study DVT was the indication in 15.62%.The cases where fibroid was the cause of DVT [39], after the surgical treatment for fibroid, anticoagulants can be stopped after ensuring the recanalisation of the blood vessels. This prevents the patient from the prolonged or life long exposure of anticoagulants and their associated risks of major and minor bleeding episodes.…”

Acute lower limb ischaemia secondary to aortic compression from uterine fibroid

“…Apart from the adjacent organs, extrinsic compression onto the blood vessels have also been described. Most of these cases involved the venous system and presented as venous thrombosis 9–11. Arterial thrombosis in relation to uterine fibroid is extremely rare.…”