Li Ling, Shen Jihong, Gao Zhenhua, Wang Xingqi, Tian Daoming, Yang Xunguo, Zhou Hang, Li Bailuan, Tang Dan, Zhang Quan
The First Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
Department of Obstetrics, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
Front Surg. 2023 Feb 13;10:1071247. doi: 10.3389/fsurg.2023.1071247. eCollection 2023.
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.
子宫平滑肌瘤,也称为子宫肌瘤,是女性生殖系统中最常见的良性肿瘤。经阴道脱垂的黏膜下平滑肌瘤是产后子宫肌瘤的一种罕见并发症。由于关于这些罕见并发症及其不常见表现的公开证据不足,它们常常给临床医生带来诊断和治疗困难。本病例报告介绍了一名初产妇,在紧急剖宫产术后出现反复高热和菌血症,产前无特殊检查。产后第20天,发现阴道有一脱垂肿物,最初被误诊为膀胱脱垂,后来更正诊断为黏膜下子宫平滑肌瘤阴道脱垂。通过及时使用强效抗生素和经阴道肌瘤切除术,该患者得以保留生育能力,而非接受子宫切除术。对于产后患有子宫肌瘤且反复发热但找不到感染源的产妇,应高度怀疑子宫黏膜下平滑肌瘤感染。进行影像学检查有助于诊断疾病,对于没有明显血供或能够实现蒂部处理的脱垂肌瘤病例,经阴道肌瘤切除术应作为治疗的首选方法。