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Li L, Shen J, Gao Z, Wang X, Tian D, Yang X, Zhou H, Li B, Tang D, Zhang Q. Transvaginal prolapsed submucosal leiomyoma after cesarean section misdiagnosed as bladder prolapse: A case report with literature review. Front Surg 2023; 10:1071247. [PMID: 36860950 PMCID: PMC9968760 DOI: 10.3389/fsurg.2023.1071247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023] Open
Abstract
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.
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Affiliation(s)
- Ling Li
- The First Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jihong Shen
- The First Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhenhua Gao
- The First Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xingqi Wang
- The First Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Daoming Tian
- The First Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xunguo Yang
- The First Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hang Zhou
- The First Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bailuan Li
- Department of Obstetrics, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Dan Tang
- Department of Obstetrics, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Quan Zhang
- The First Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, China,Correspondence: Quan Zhang
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Rokas A, Mesiano S, Tamam O, LaBella A, Zhang G, Muglia L. Developing a theoretical evolutionary framework to solve the mystery of parturition initiation. eLife 2020; 9:e58343. [PMID: 33380346 PMCID: PMC7775106 DOI: 10.7554/elife.58343] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/08/2020] [Indexed: 11/13/2022] Open
Abstract
Eutherian mammals have characteristic lengths of gestation that are key for reproductive success, but relatively little is known about the processes that determine the timing of parturition, the process of birth, and how they are coordinated with fetal developmental programs. This issue remains one of biology's great unsolved mysteries and has significant clinical relevance because preterm birth is the leading cause of infant and under 5 year old child mortality worldwide. Here, we consider the evolutionary influences and potential signaling mechanisms that maintain or end pregnancy in eutherian mammals and use this knowledge to formulate general theoretical evolutionary models. These models can be tested through evolutionary species comparisons, studies of experimental manipulation of gestation period and birth timing, and human clinical studies. Understanding how gestation time and parturition are determined will shed light on this fundamental biological process and improve human health through the development of therapies to prevent preterm birth.
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Affiliation(s)
- Antonis Rokas
- Department of Biological Sciences, Vanderbilt University, Nashville, United States
| | - Sam Mesiano
- Department of Reproductive Biology, Case Western Reserve University and Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Cleveland, United States
| | - Ortal Tamam
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Abigail LaBella
- Department of Biological Sciences, Vanderbilt University, Nashville, United States
| | - Ge Zhang
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center and Department of Pediatrics. University of Cincinnati College of Medicine, Cincinnati, United States
| | - Louis Muglia
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center and Department of Pediatrics. University of Cincinnati College of Medicine, Cincinnati, United States
- Burroughs Wellcome Fund, Research Triangle Park, Durham, United States
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Gerome JM, Church TL. Puerperal Complications of a Retroplacental Uterine Leiomyoma. J Osteopath Med 2017; 117:660-663. [PMID: 28973183 DOI: 10.7556/jaoa.2017.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Leiomyoma can be found concomitant with pregnancy and can cause complications during labor, delivery, and postpartum management. In the present case, a 26-year-old nulliparous patient at 39.4 weeks gestational age with a 12×9-cm retroplacental leiomyoma underwent a spontaneous vaginal delivery. Nine weeks after delivery, the patient presented with acute pain and vaginal bleeding. Immediate manual removal of the bulk of the leiomyoma tissue via vaginal approach was performed. Four weeks later, the patient returned for removal of the remaining tissue via hysteroscopic excision. This case demonstrates that a large retroplacental leiomyoma can be associated with both immediate and delayed postpartum complications, and it can be managed in a minimally invasive way.
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Elgonaid W, Belkhir R, Boama V. Transvaginal postpartum manual removal of a prolapsed submucous leiomyoma, initially diagnosed hybrid predominantly intramural. BMJ Case Rep 2017; 2017:bcr-2016-218712. [PMID: 28801323 DOI: 10.1136/bcr-2016-218712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a rare case of a large infarcted submucous fibroid removed manually after a normal vaginal delivery. This patient was known to have a large postero-fundal hybrid predominantly intramural uterine fibroid, measuring 11 x 10 cm in diameter and diagnosed 2 years prior to last conception. Thirty-five days postpartum, she presented with severe lower abdominal pain and foul smell per vaginum. Abdominal examination revealed a very tender bulky uterus at 24 weeks size, and vaginal examination revealed a big fleshy smelly mass with friable surface just bulging from a dilated cervix. Examination under anaesthesia revealed a very foul smelly large pedunculated submucous fibroid that was felt through a dilated cervix. It was deliverable vaginally, so the submucous leiomyoma was removed manually, a procedure similar to manual removal of placenta. Histopathology examination confirmed an infarcted massive fibroid.
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Affiliation(s)
- Wael Elgonaid
- Department of Obstetrics & Gynaecology, Sidra Medical & Research Centre, Doha, Qatar
| | - Reem Belkhir
- Department of Obstetrics & Gynaecology, Hamad Medical Corporation, Doha, Qatar
| | - Vincent Boama
- Department of Obstetrics & Gynaecology, Sidra Medical & Research Centre, Doha, Qatar
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