Pedunculated Fibroid
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.
They even grow big. Last year, I have seen the biggest fibroid case, reported in the East African Medical Journal. A 37 year old woman had an abdominal inflammation due to the large growth of this fibroid. Her surgeons diagnosed nearly 16 centimeters long and one and half a kilogram weighed fibroid.
This woman was fortunate to experience no symptoms beyond the swelling, but others are not as lucky when it comes to their experiences with pedunculated fibroids.
In some women, submucosal pedunculated fibroids extend into the vaginal canal, which causes distress during sexual intercourse. Two patients treated by the American University of Beirut Medical Center were found to have such fibroids. A full 12 cm of one patients submucosal fibroid had grown into the vaginal canal, while the rest of the growth remained in her uterus.
When the stalk gets distorted it causes severe pain but very few faces this problem. It is very risk if the fibroid in the stalk grows.
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.
Often prior to a myomectomy the woman is required to sign an agreement to allow a hysterectomy to be performed should anything go wrong during the procedure, so women that undergo this procedure sometimes wake up without a uterus.