Vaginal Myomectomy for Prolapsed Submucous Fibroid: It is Not Only About Size

Abstract

Leiomyoma of the uterus, also called fibroids, are common in women. In this case report, we describe the case of a nulliparous woman with a large, prolapsed submucous uterine leiomyoma of 10 × 11 cm was vaginally impacted. The aim is to highlight the challenges in managing such uncommon clinical scenario focusing on the factors predicting the success of vaginal myomectomy including the size of the myoma but also the role of vaginal laxity to allow the steps of devascularization, detachment, and removal of the myoma. We also describe the preoperative and intraoperative methods that can be used to minimize intraoperative blood loss and enhance the safety and feasibility of the surgical procedure. Gonadotropin therapy was not applicable in our patient, and other treatments were also unavailable such as temporary ligation of uterine arteries, while others were unsuccessful like devascularization by hysteroscopy, twisting, and ligation of the pedicle. The final resort used in our case was morcellation of the myoma with intact pedicle, which should be attempted by experienced gynecologic surgeons only.

Bilateral obstructive uropathy and severe renal dysfunction associated with large prolapsed pedunculated submucosal leiomyoma of the uterus misdiagnosed as an intracervical fibroid: Report of a very rare case and a mini‑review of the literature

“…The clinical diagnosis of a prolapsed pedunculated submucosal uterine leiomyoma within the vagina can be challenging, particularly in cases where the leiomyoma is of A notable size and has a short vascular pedicle. Prolapse of a pedunculated submucosal leiomyoma through the cervix may either be asymptomatic or manifest with symptoms, such as vaginal bleeding, vaginal discharge, or pelvic pain ( 9 ). In the patient described in the present study, the association of a prolapsed pedunculated submucosal uterine leiomyoma with bilateral chronic obstructive uropathy and renal dysfunction appears to be unique in the English literature.…”

Prolapse of a large pedunculated uterine myoma

“…1 Most myomas are small but variable in size, between 1 cm and 6 cm; however, some case reports in the literature have reported prolapse of larger myomas, measuring more than 10 cm in diameter. 2 Surgery has been the mainstay of prolapsed pedunculated leiomyomas, with both vaginal removal and hysterectomy being safe. 1 Lower parity, absence of coexisting leiomyoma, low volume of leiomyoma, and more severe anemia were associated with preference of vaginal removal.…”