Uncommon Complication of Uterine Artery Embolization: Expulsion of Infarcted Myoma and Uterine Sepsis

Martins, José Augusto; Crespo, Frank A.; Ganesh, D; Verma, Usha

doi:10.1155/2016/8695318

Cited by 12 publications

(20 citation statements)

References 22 publications

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“…Above mentioned process of expulsion of necrotic myoma's tissue is similar to the sloughing off myomas after embolisation, where MRI images are almost identical to presented above [9,10]. Also, symptoms presented by our patient (abdominal pain, fever, increase of CRP level) may suggest 'post-embolisation syndrome', which is an acute reaction for ischemia of myoma.…”

Section: Discussionsupporting

confidence: 76%

Spontaneous Vaginal Expulsion of the Uterine Myomas - Vaginal Expulsion of Myomas

Joanna¹,

Pawel²,

Jacek³

2018

Med Case Rep

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Spontaneous vaginal expulsion is a really rare condition which without proper treatment may cause many lifethreatening complications. Therefore, we present the case of a young woman who was admitted to a gynecological ward because of the heavy menstrual bleeding, abdominal pain since 3 weeks, anemia and fever.The patient did not reveal any medical history. During the hospitalization spontaneous, vaginal expulsions of a purple-grey, stinking tissue were observed. Because of the unclear symptomatology and imprecise results of ultrasound scans, she was subjected to a detailed examination. The spontaneous, unusual vaginal expulsion of the uterine myomas was diagnosed.According to authors knowledge it is the first case study in unusually young women, which shows spontaneous expulsion of myomas without known reason. By this study, authors want to increase awareness of this disease process, present multiple diagnostic dilemmas which can delay diagnosis and show different ways of treatment.

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Section: Discussionsupporting

confidence: 76%

Spontaneous Vaginal Expulsion of the Uterine Myomas - Vaginal Expulsion of Myomas

Joanna¹,

Pawel²,

Jacek³

2018

Med Case Rep

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“…Pagrindinės GAE kontraindikacijos yra nėštu-mas, genitourinarinės sistemos infekcija, piktybiniai navikai, imunosupresinė būklė. Didelių matmenų ir submukozinės lokalizacijos miomos nėra kontraindikacijos GAE procedūrai atlikti [10].…”

Section: įVadasunclassified

“…pacienčių. Buvo pastebėta, kad komplikacijų dažnis atliekant GAE yra didesnis, jei mioma yra submukozinės lokalizacijos arba didesnė nei 10 cm, tačiau statistiškai patikimų duomenų nėra [10].…”

Section: įVadasunclassified

Gimdos Miomų Gydymas Atliekant A.UTERINA Embolizaciją: Lietuvos Sveikatos Mokslų Universitetinės Ligoninės Kauno Klinikų, Vilniaus Respublikinės Universitetinės Ligoninės Ir Klaipėdos Universitetinės Ligoninės Patirtis

Uljanionok¹,

Bykovaitė²,

Romeikienė³

et al. 2017

Medicinos Teorija Ir Praktika

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Reikšminiai žodžiai: gimdos miomos, fibromos, lejomiomos, gimdos arterijų embolizacija. Darbo tikslas. Įvertinti gimdos arterijų embolizacijos, taikomos gydyti gimdos miomas, dažnį ir rezultatus. Tyrimo medžiaga ir metodai. Retrospektyviai analizuotos 2008–2015 m. Lietuvos sveikatos mokslų universiteto ligoninės (LSMUL) Kauno klinikose, Respublikinėje Vilniaus universiteninėje ligoninėje ir Klaipėdos universitetinėje ligoninėje gydytų moterų ligos istorijos (n = 13), kurioms buvo taikyta gimdos arterijų embolizacija (GAE) simptominėms gimdos lejomiomoms gydyti. Gimdos lejomiomos diagnozė (TLK D25) buvo patvirtinta ultragarsiniu arba magnetinio rezonanso tyrimu ir ginekologiniu ištyrimu. Atlikta moterų anketinė apklausa siekiant įvertinti jų pasitenkinimą procedūra ir gimdos miomų simptomatikos dinamiką po procedūros. Rezultatai. Prieš gimdos arterijų embolizaciją 61,5 proc. moterų buvo nustatyta anemija. Visos moterys prieš procedūrą skundėsi gausiomis ir skausmingomis menstruacijomis (p < 0,05), beveik pusei (46,2 proc.) pasireiškė spaudimo jausmas pilvo srityje. Vertinant ultragarsinio tyrimo duomenis po atliktos embolizacijos, 76,9 proc. atvejų miomų dydis sumažėjo. Pakartotinos procedūros nereikėjo nė vienai pacientei. Visos apklaustos pacientės procedūrą vertina teigiamai. Po gimdos arterijų embolizacijos skausmingos, gausios mėnesinės, spaudimo jausmas pilvo srityje visoms sumažėjo. Tik 1 iš 8 moterų, kurioms prieš embolizaciją buvo nustatyta anemija, ji išliko ir po procedūros. Išvados. Gimdos miomų gydymas atliekant gimdos arterijų embolizaciją net didžiausiose ir pažangiausiose Lietuvos ligoninėse yra taikomas retai. Visos moterys procedūrą įvertino teigiamai. Po gimdos arterijų embolizacijos 76,9 proc. atvejų miomos dydis sumažėjo ir tik 7,6 proc. tiriamųjų vėliau prireikė operacinio gydymo.

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“…Hysterectomy is an invasive procedure that is associated with significant morbidities, 10-15% complication rates as well as lengthy hospital stay and prolonged recovery time (2) . Patient's desire to preserve their uterus has prompted the development of uterus sparing alternatives as laparoscopic, hysteroscopic myomectomies (3) . Presence of multiple fibroids with variable sizes, locations, adding to associated pain, high post-operative morbidity as well as symptoms recurrence (25% of patients] have made myomectomy not feasible in all circumstances (4) .…”

Section: Introductionmentioning

confidence: 99%

“…As a tool to assess technical success of UAE; all patients were subjected to pelvic MRI with contrast six months following the procedure to evaluate reduction in both uterine, dominant leiomyoma volumes as well as need for re-interventions whether repeated UAE or subsequent myomectomies and hysterectomies. The volumes of the uterus and the dominant leiomyomata were calculated in cm 3 pre-procedural as a base line and 6 months post-procedural using the formula for a simplified prolate ellipse (L X W X D X .542) as described by Orsini et al (10) . The uterine fibroid shrinkage volume inferred from pre and post-operative MRI scans will be correlated with symptomatic improvement/ deterioration or stability.…”

mentioning

confidence: 99%

Measurement of Uterine Leiomyomata Volume Pre and Post Uterine Artery Embolization Aided by MRI

Aly

Abdullah²,

Botros³

2018

The Egyptian Journal of Hospital Medicine

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Background: uterine fibroid embolization (UFE) is now evolving to be the first-line treatment for symptomatic uterine leiomyomata alongside the conventional surgical treatment of hysterectomy and myomectomy. Cochrane review comprises six RCTs comparing UAE versus hysterectomy or myomectomy for management of symptomatic leiomyomata where UFE had similar short and midterm outcomes, inclusive of symptomatic relief, quality of life and patient satisfaction, while benefiting from uterine preservation, shorter hospital stay and a faster recovery before resuming ordinary life activities. These benefits are in line with the minimally invasive nature of the embolization procedures. Aim of the Work: t this study aimed to review and illustrate the role of MR imaging in the pre-and post-procedural assessment for uterine fibroid patients undergoing uterine artery embolization. Patients and Methods: the current study was carried out in Radiodiagnosis Department, Faculty of Medicine, Ain shams University and specialized private radiology centers during the period between April 2017 and December 2017. It included 30 patients that were referred from gynecology clinic with their ultrasonographic reports to Radiodiagnosis Department, body imaging unit with a view to carry-out pelvic MRI with contrast. Results: imaging follow-up via pelvic MRI with contrast was obtained in 30 patients at 3, 6 months after treatment. The mean uterine volume was reduced by 25% (standard deviation was SD 0.03763) 3 months after treatment and was further reduced by a mean of 30% (SD 0.02638) by six months after treatment. Post-procedural subtraction MRI revealed mean myoma enhancement to be 5.6 + 0.5 SI in contrast to 133.4 + 18.3 SI prior to UFE. The mean dominant fibroid volume reduced by 34 % (SD 0.09247) after 3 months, 44 % (SD 0.05994) after 6 months. A cumulative reduction in both uterine and dominant leiomyoma mean volume from baseline to 6 months post -UAE was evident with significant interval changes between 3, 6 months follow up (p 0.000) Conclusion: the MRI findings following UAE vary with the interval from embolization and success of the procedure. MRI with its multiplanar capabilities was typically employed to evaluate the uterus following UAE for fibroid infarction, size reduction, location change, persistent enhancement, fibroid recurrence, changes in adenomyosis, and unexpected complications that may require surgical intervention or identify women who would benefit from repeated UAE. Recommendations: further studies on a larger scale of patients are needed to confirm the results obtained by this work.

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Uncommon Complication of Uterine Artery Embolization: Expulsion of Infarcted Myoma and Uterine Sepsis

Cited by 12 publications

References 22 publications

Spontaneous Vaginal Expulsion of the Uterine Myomas - Vaginal Expulsion of Myomas

Spontaneous Vaginal Expulsion of the Uterine Myomas - Vaginal Expulsion of Myomas

Gimdos Miomų Gydymas Atliekant A.UTERINA Embolizaciją: Lietuvos Sveikatos Mokslų Universitetinės Ligoninės Kauno Klinikų, Vilniaus Respublikinės Universitetinės Ligoninės Ir Klaipėdos Universitetinės Ligoninės Patirtis

Measurement of Uterine Leiomyomata Volume Pre and Post Uterine Artery Embolization Aided by MRI

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