What does a prolapsed fibroid look like

Under a Creative Commons license

Open access

Abstract

INTRODUCTION

Inversion of the uterus is an extremely rare complication of the non-puerperal period and is commonly caused by benign submucous, especially fundal, leiomyomas. A case of a totally inverted cervix due to a prolapsed huge cervical leiomyoma mimicking chronic non-puerperal uterine inversion in a perimenopausal woman is presented.

PRESENTATION OF CASE

A 52-year-old perimenopausal woman was admitted to our clinic with an ulcerated, necrotic, infected and swollen prolapsed mass. Gynecologic history revealed that she was advised myomectomy because of her cervical myoma 2 years ago but she refused to have an operation as she believed that her positive thoughts would shrink the myoma. Presumed diagnosis before surgery was chronic non-puerperal uterine inversion. An intraoperative diagnosis was totally inverted cervix due to a huge cervical leiomyoma. Vaginal hysterectomy without adnexectomy, was performed.

CONCLUSION

This is the first case in the literature which a totally inverted cervix due to a prolapsed huge cervical leiomyoma. Cervical fibroids can grow in perimenopausal period and in extremely rare cases can cause total cervical inversion.

Keywords

Cervical inversion

Prolapsed leiomyoma

Uterine inversion

Vaginal hysterectomy

Copyright © 2014 The Authors. Published by Elsevier Ltd.

Topic Resources

Cervical myomas are smooth, benign tumors in the cervix.

• A cervical myoma may bleed, become infected, interfere with urinating, or cause pain during sexual intercourse.

• Doctors can see or feel most myomas during a pelvic examination.

• Myomas that cause symptoms can be removed surgically.

Large cervical myomas may partially block the urinary tract or may protrude (prolapse) into the vagina. Sores sometimes develop on prolapsed myomas, which may become infected, bleed, or both. Rarely, prolapsed myomas can also block the flow of urine.

Most cervical myomas eventually cause symptoms. The most common symptom is

• Bleeding from the vagina, which may be irregular or heavy

Heavy bleeding can cause anemia, with fatigue and weakness. Sexual intercourse may be painful.

If myomas become infected, they may cause pain, bleeding, or a discharge from the vagina.

Rarely, prolapse causes symptoms such as a feeling of pressure or a lump in the pelvis.

Rarely, if a myoma blocks the flow of urine, women may have a hesitant start when urinating, dribble at the end of urination, and retain urine. Urinary tract infections are more likely to develop.

• Pelvic examination

• Sometimes imaging tests such as ultrasonography or magnetic resonance imaging (MRI)

If the diagnosis is uncertain, doctors may insert an ultrasound device through the vagina into the uterus to obtain an image of the area. This procedure, called transvaginal ultrasonography Other tests

Blood tests are done to check for anemia.

• If myomas cause symptoms, surgery

If myomas are small and do not cause any symptoms, no treatment is needed.

If myomas cause symptoms, they are surgically removed if possible (a procedure called myomectomy). If only the myoma is removed, women can still bear children. However, if myomas are large, removal of the entire uterus (hysterectomy) may be necessary. Either procedure can be done by making a large incision in the abdomen (laparotomy). Sometimes these procedures can be done with instruments inserted through one or more small incisions near the navel (laparoscopy).

If a myoma protrudes into the vagina, it is removed with instruments inserted through the vagina (transvaginally) if possible.

CLICK HERE FOR THE PROFESSIONAL VERSION