Our Summary

This article discusses the case of a young woman who experienced unusual vaginal bleeding two weeks after a surgical procedure to remove fibroids from her uterus. Her post-surgery recovery seemed normal at first. However, a vaginal ultrasound revealed a strange, pulsating, fluid-filled sac in the lower part of her uterus. This sac was connected to both an artery and a vein. Further testing through a CT scan confirmed that this sac was an abnormal blood vessel growth inside the muscular layer of her uterus. This condition was treated by blocking the blood flow to the abnormal growth, leading to the woman’s full recovery.

FAQs

  1. What is a uterine pseudoanevrysm and how is it diagnosed?
  2. What complications can arise after an abdominal myomectomy?
  3. What is selective arterial embolization and how is it used in the treatment of uterine pseudoanevrysm?

Doctor’s Tip

One helpful tip a doctor might tell a patient about myomectomy is to be aware of the signs of complications, such as abnormal vaginal bleeding, and to seek medical attention if any unusual symptoms occur after the procedure. It is important to follow up with your healthcare provider regularly to monitor for any potential complications and to address any concerns promptly.

Suitable For

Patients who are typically recommended myomectomy are those who have symptomatic uterine fibroids that are causing heavy menstrual bleeding, pelvic pain, pressure on the bladder or bowel, or fertility issues. Myomectomy may be recommended for women who wish to preserve their fertility or who desire to avoid a hysterectomy. Additionally, myomectomy may be recommended for patients with large fibroids or those who have not responded to other treatments such as medication.

Timeline

Before myomectomy:

  • Patient consults with gynecologist for abnormal vaginal bleeding and pelvic pain
  • Gynecologist recommends myomectomy to remove uterine fibroids causing symptoms
  • Patient undergoes pre-operative testing and preparation for surgery
  • Surgery is scheduled and patient is informed of potential risks and complications

After myomectomy:

  • Patient undergoes surgery and is monitored in recovery for any immediate complications
  • Patient is discharged from the hospital and instructed on post-operative care and follow-up appointments
  • Two weeks after surgery, patient experiences abnormal vaginal bleeding and presents to the hospital for evaluation
  • Transvaginal sonography detects a pulsatile cystic area in the uterine myometrium, indicating a uterine pseudoaneurysm
  • Computed tomographic angiography confirms the diagnosis and patient undergoes selective arterial embolization for treatment
  • Patient experiences complete recovery following embolization and is monitored for any further complications in the future.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a myomectomy?

  2. How long will the recovery process be after a myomectomy?

  3. Will a myomectomy affect my fertility or future pregnancies?

  4. Are there any alternative treatment options to a myomectomy that I should consider?

  5. What is the success rate of a myomectomy in treating my specific condition?

  6. How many myomectomies have you performed and what is your experience with this procedure?

  7. Will I need any additional tests or imaging studies before the myomectomy?

  8. What type of anesthesia will be used during the myomectomy procedure?

  9. How long will I need to stay in the hospital after the myomectomy?

  10. What are the signs of complications that I should watch out for after the myomectomy?

Reference

Authors: Rossard L, Body G, Ouldamer L. Journal: J Gynecol Obstet Hum Reprod. 2021 Jun;50(6):101877. doi: 10.1016/j.jogoh.2020.101877. Epub 2020 Jul 24. PMID: 32717332