Surgical treatment of a huge submucous myoma prolapsed into the vagina

Year 2016, Volume: 47 Issue: 3, 0 - 0, 01.09.2016

Yıldız Akdaş Reis Derya Akdağ Cırık , Tolga Taşcı , Kerime Salihoğlu Nurettin Boran Gokhan Tulunay , Taner Turan

Abstract

Nearly 5% of all myomas are originated from the smooth muscle of uterus, beneath the endometrium and called as ‘submucous myoma’. Submucous myomas distort the cavity when they enlarge and may even pass the cervix and reach to the vagina by uterine contractions. The most common treatment of the myomas prolapsing the vagina is the vaginal myomectomy. However, abdominal treatment may be necessary when the submucous myom grow within the cavity and enlarge the uterus. This paper presents a case of huge submucous myoma with a suspician of leiomyosarcoma in the magnetic resonance imaging, that grow into very big size within the cavity and completely fill the vagina. A 45-years-old multiparous women with a complaint of vaginal bleeding was diagnosed to have a 8 cm necrotic submucous myoma prolapsed into vagina after pelvic examination with speculum. Due to the combination of malignancy risk and uterus with three-month gravida size, abdominal exporation with laparotomy was planned for the patient. In the abdominal exploration, a 14*13*12 cm submucous myoma growing into the endometrial cavity was observed and abdominal hysterectomy was planned. After completion of abdominal hysterectomy, vajinal part of myoma was tried to extract abdominally but it could not. Due to the complete replacement of vaginal cavity by the myoma, vajinal part of myoma can only be extracted by vaginal approach.

Keywords

Submucous myoma, hysterectomy, surgery

Vajene doğmuş dev submüköz myomun cerrahi tedavisi: Olgu sunumu

Abstract

Tüm myomların yaklaşık %5’ini oluşturan submüköz myomlar, endometriumun hemen altındaki kas tabakasından kaynaklanırlar ve büyüdükçe uterin kaviteyi distorte ederler. Kavite içinde olan saplı submüköz myomlar ise, uterin kontraksiyonlarla bazen serviksten geçerek vajene kadar ilerleyebilirler. Vajene doğmuş myom diye adlandırılan bu myomların en sık tedavi şekli vajinal yolla yapılan myomektomidir. Ancak nadiren, myomun kavite içindeki bölümünü de çok büyük boyutlara ulaşırsa abdominal yaklaşım gerekli olabilir. Bu yazıda vajeni tamamen dolduran, kavite içinde de dev büyüklüğüne ulaşan ve preoperatif dönemde yapılan manyetik rezonans görüntülemede leiomyosarkom şüphesi olan bir olgu sunulmuştur. Yaklaşık 2 aydır vajinal kanama şikayeti olan 45 yaşındaki multipar hastanın, yapılan spekulum muayenesinde vajeni tamamiyle dolduran 8 cm çapında kötü kokulu nekrotik bir kitlesi saptanmıştır. Uterusun 3 aylık cesamette olması 12 cm büyüklüğüne ulaşan submüköz myom izlenmesi üzerine hastaya abdominal histerektomi yapılmıştır. Ancak myomun vajendeki bölümü abdominal olarak çıkarılamamıştır. Myom vajinayı tamamiyle doldurmuş olduğundan bu kısım vajinal yolla eksize edilmiştir. 

Keywords

Submüköz myom, histerektomi, cerrahi

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