Pedunculated Fibroid
Pedunculated fibroids are non-cancerous uterine growths attached to the uterine wall by a peduncle, a stalk-like growth. Those that grow inside the uterus are known as pedunculated submucosal fibroids, and those that develop outside the uterus are known as subserous pedunculated fibroids.
Pedunculated fibroids can become quite large. An article in the East African Medical Journal last year reported that a 37-year-old woman presented with significant, increasing abdominal swelling. Surgeons removed a 1.5 kg pedunculated fibroid that was almost 16 cm in length.
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 possibility that can occur when the fibroid becomes twisted is a blockage in the blood and nutrient supply to the fibroid through a kink in the veins. Once this occurs the fibroid will begin to die, which will not only increase the danger of infection, but is also quite painful.
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 found that up to 10% of patients who undergo Uterine Artery Embolization for pedunculated fibroids encounter regrowth of their fibroids after 2 years. For this reason, they recommend that the procedure be repeated after 2 years.
Another common treatment for pedunculated fibroids is Myomectomy. A procedure in which the fibroid is surgically removed and the uterus repaired by the surgeon. This surgery does not, however, have a 100% success rate as Doctors at the University of South Dakota have reported a case where they attempted a myomectomy on a patient. The woman had experienced a ruptured blood vessel in a large pedunculated fibroid while giving birth. The attempted myomectomy was unsuccessful, and they were forced to perform an emergency hysterectomy instead.
Because the success rate for myomectomies is not 100%, women are usually asked to sign a waiver that specifies a hysterectomy if the surgery is not successful. Some women have gone in for one procedure and awakened after having two.