Pedunculated fibroids are fibroids which are attached by a stalk to the uterus; this stalk is known as a peduncle. Those pedunculated fibroids that appear on the outside of the uterus are known as subserous pedunculated fibroids, while those that appear inside the uterus are known as pedunculated submucosal fibroids.
The fibroids can grow to become quite large in size; among the largest reported ones I discovered was reported last year by the East African Medical Journal. A 37 year old woman had abdominal swelling that simply continued to grow. The surgeons discovered that she had a pedunculated fibroid nearly 16 centimetres in length and weighing almost a kilogram and a half.
One of the most startling things about this patients condition was that she had no symptoms other than the abdominal swelling. Other women who develop pedunculated fibroids have a much different experience.
Occasionally pedunculated submucosal fibroids can protrude into the vaginal canal, bringing pain during sexual intercourse. The American University of Beirut Medical Center has reported two women that had prolapsed pedunculated submucosal fibroids, one of these patients fibroids had 12 centimetres of the fibroid prolapsed into the vaginal canal while the rest of it remained in the uterus.
Pedunculated fibroids can be painful, particularly if the peduncle becomes twisted. The risk of the peduncle twisting increases as the fibroid grows larger.
Other painful symptoms that are often associated with these fibroids are uterine cramps, as well as pressure on the uterus along with other organs.
Some women with pedunculated submucosal fibroids experience light to moderate bleeding throughout their menstrual cycles. Those women who experience continuous bleeding usually see an increase in bleeding during the time of their regular period.
If a pedunculated fibroid becomes twisted, the patient may need emergency surgery. The pain of a twisted peduncle can be so excruciating that the patient requests any possible procedure to alleviate it.
Another effect of twisted peduncle is a blockage or twist in veins that supplies the fibroid with blood and nutrients. These fibroid perishes if the supply is blocked and hence causes severe pain and enhances the infection rate.
If the stalk is 2 centimeters or more, a Uterine Artery Embolization is suggested. The intention is to obstruct the blood supply to the fibroids, which reduces the growth and shrinks and later dies. But the University of Toronto stated these sub-serous fibroids have failed with Uterine Artery Embolization expect in other types of fibroids.
Doctors at the Bretonneau Hospital in France have begun recommending for women who have undergone the procedure to undergo it again after 2 years as it has been found that approximately 10% experience growth of the fibroids again within that time. They have also discovered that the procedure does not inhibit fibroids from growing back.
Another procedure often used to treat pedunculated fibroids is a myomectomy. In this procedure, the surgeon removes the fibroid and repairs the uterus. Myomectomy is not always 100% successful. In one case reported by the University of South Dakota, an unsuccessful myomectomy was performed, leading to an emergency hysterectomy for the patient.
Before hysterectomy surgeries, it is very reasonable to sign papers as an approval, as things may go wrong or sometimes for very few women uterus has to be removed.
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