Our Summary

This research paper discusses two unique cases where patients had complications following a procedure to remove uterine fibroids (myomectomy) that had slipped down into the uterus lining (prolapsing submucous myomas) after a treatment to block the blood supply to these fibroids (uterine artery embolization, or UAE). These complications involved the patients developing a blood infection (bacteremia). The first patient recovered after being treated with antibiotics through an IV, while the second patient improved after undergoing another surgery to remove a dead fibroid and to examine the abdominal area. These cases are meant to warn doctors about the rare but serious risk of blood infection in patients who have this type of fibroid removal procedure after having UAE treatment.

FAQs

  1. What is the risk of complications with hysteroscopic myomectomy?
  2. What is the possible rare incidence that can occur in patients undergoing hysteroscopic myomectomy with prior UAE treatment?
  3. What treatments are available for patients who develop bacteremia after a hysteroscopic myomectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about myomectomy is to watch for any signs of infection after the procedure, such as fever, increased pain, or abnormal discharge. It is important to seek medical attention promptly if any of these symptoms occur, as early detection and treatment of infection can prevent serious complications.

Suitable For

Patients who are typically recommended for myomectomy include those with symptomatic uterine fibroids, such as heavy menstrual bleeding, pelvic pain, and pressure symptoms. Patients with submucous or intramural fibroids that are causing infertility or recurrent pregnancy loss may also be candidates for myomectomy. Additionally, patients who have tried conservative management options for their fibroids without success may be recommended for myomectomy. It is important for patients to undergo a thorough evaluation by their healthcare provider to determine if myomectomy is the appropriate treatment option for their specific condition.

Timeline

Before myomectomy:

  • Patient undergoes uterine artery embolization (UAE) for prolapsing submucous myomas
  • Prolapsing myoma occurs at varying times after completion of UAE
  • Patient experiences symptoms such as bacteremia

After myomectomy:

  • Patient receives intravenous antibiotic treatment for sepsis
  • Patient may require additional procedures such as abdominal myomectomy or explorative laparotomy for removal of necrotic myoma
  • Recovery and status improvement post-surgery

Overall, the timeline includes UAE, onset of prolapsing myoma, symptoms of sepsis, myomectomy, and recovery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with hysteroscopic myomectomy for prolapsing submucous myomas after UAE?
  2. How long should I wait after undergoing UAE before considering hysteroscopic myomectomy?
  3. Will I need to undergo any additional tests or evaluations before the myomectomy procedure?
  4. What is the success rate of hysteroscopic myomectomy for prolapsing submucous myomas after UAE?
  5. How long is the recovery period expected to be after the myomectomy procedure?
  6. Are there any alternative treatment options for my condition that I should consider?
  7. How experienced are you in performing hysteroscopic myomectomy procedures?
  8. What is your plan for managing any potential complications that may arise during or after the procedure?
  9. Will I need to take any medications or follow a specific post-operative care plan after the myomectomy?
  10. What should I do if I experience any unusual symptoms or complications after the myomectomy procedure?

Reference

Authors: Chua KJC, McLucas B. Journal: Minim Invasive Ther Allied Technol. 2022 Apr;31(4):646-648. doi: 10.1080/13645706.2020.1864407. Epub 2021 Jan 5. PMID: 33399491