Transvaginal postpartum manual removal of a prolapsed submucous leiomyoma, initially diagnosed hybrid predominantly intramural

Transvaginal prolapsed submucosal leiomyoma after cesarean section misdiagnosed as bladder prolapse: A case report with literature review

Uterine leiomyomas, also known as uterine fibroids, are the most common benign tumors found in the female reproductive system. Transvaginal prolapsed submucosal leiomyomas are a rare complication of uterine fibroids during the postpartum period. Due to the lack of sufficient published evidence on these rare complications and their uncommon appearance, they often result in diagnostic and treatment difficulties for clinicians. This case report presents a primigravida with no special prenatal examination developed recurrent high fever and bacteremia following an emergency cesarean section. On the 20th day after delivery, a vaginal prolapsed mass was observed, which was initially misdiagnosed as bladder prolapse before being corrected to a diagnosis of vaginal prolapse of submucosal uterine leiomyoma. This patient was able to retain fertility by prompt use of powerful antibiotics and transvaginal myomectomy rather than undergoing a hysterectomy. For parturient women with hysteromyoma and recurrent fever after delivery where the source of infection cannot be found, the infection of the submucous leiomyoma of the uterus should be highly suspected. It can be helpful to perform an imaging examination to diagnose a disease, and transvaginal myomectomy should be the first choice for treating prolapsed leiomyoma in cases with no obvious blood supply or if pedicle can be achieved.

Prolapsed submucosal pyomyoma postpartum, a rare complication of fibroids

Background

Pyomyoma is an unusual fibroid that usually develops during the puerperal or postmenopausal period. If not promptly diagnosed and treated, it can become life threatening. Although various conservative and surgical therapies have been discussed in the literature for this condition, there are very few reports related to the management of prolapsed pedunculated submucosal myoma.

Case presentation

In this case report, an intramural fibroid transformed into a pedunculated submucosal pyomyoma, which prolapsed into the vagina after a miscarriage and caused life-threatening toxic shock. Apart from prompt antibiotic treatment, a transabdominal myomectomy rather than hysterectomy was performed due to the very large diameter of the pyomyoma. As a result, fertility was preserved, and the patient conceived naturally and delivered a healthy baby two years later.

Discussion and conclusions

It is important to maintain strong clinical suspicion for pregnant or postpartum women with a triad of pain, sepsis without an obvious source and a known diagnosis of leiomyoma. Timely recognition and prompt surgical treatment with antibiotics are necessary and could conserve the uterus for future fertility.