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Abstract: A 46-year-old woman presented to the clinic with an abdominal mass during a physical examination, accompanied by discomfort such as frequent urination. Upon inquiry, we learned that the patient had undergone myomectomy many years ago, and the patient believed that the disease was cured after treatment, so she did not follow up regularly. The patient was given a follow-up abdominal ultrasound and was initially diagnosed with multiple uterine fibroids, and surgery was recommended. The patient agreed to undergo surgery and recovered well from the treatment, and the disease was cured.
Basic information】Female, 46 years old
Type of disease】Adenoma-like tumor (multiple uterine fibroids)
Hospital】Qilu Hospital of Shandong University
Date of consultation】September 2021
Treatment plan】Surgical treatment (transabdominal total hysterectomy, bilateral salpingo-oophorectomy, pelvic adhesion release) + intravenous infusion (sodium chloride injection, white brow snake venom hemagglutinase for injection) + oral medication (polysaccharide iron complex capsule)
[Treatment period] 1 week of treatment, 3 months of follow-up
Treatment effect】Good recovery, disease cure
I. Initial consultation
A middle-aged female patient came to the clinic and reported that she found a uterine mass during a physical examination, accompanied by symptoms of frequent urination, and recently she also occasionally experienced a feeling of lower abdominal distension. After careful questioning, we learned that the patient was pregnant with 4 cesarean sections1 and had normal menstrual cycles of 4-5 days each, with an interval of 25-28 days between each menstrual period, normal menstrual volume and less dysmenorrhea. The patient had previously undergone myomectomy at an outside hospital, but was not followed up regularly for personal reasons. The outpatient clinic gave a review of abdominal ultrasound, which indicated that the patient had an enlarged uterus with multiple fibroids of varying sizes.
II. Treatment process
After admission, the patient was given various tests, including routine blood tests, gynecological examinations and ultrasound examinations. The routine blood test showed that the hemoglobin was less than 110g/L, which might be anemia, so the patient was treated with anemia correction and given oral polysaccharide iron complex capsules. The gynecological examination showed that the patient’s uterus was enlarged and less mobile. On ultrasonography, the size of the patient’s uterus was about 63×52×56 mm, and multiple solid hypoechoic clusters were detected inside, the larger one was about 16×13×14 mm, partially protruding into the uterine cavity, the position of the uterus was normal, and the size of the cervix was normal. Based on the patient’s medical history and examination results, the diagnosis of multiple uterine fibroids was made clearly. Since the patient had large fibroids and symptoms of compression, i.e., indications for surgery existed, surgery was performed on a later date after communication with the patient. In addition, since the patient had undergone a previous cesarean section and myomectomy, there was a high possibility of intrapelvic adhesions, so she was given a total transabdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic adhesion release, and the operation went smoothly. After the operation, the patient was given sodium chloride injection for rehydration and injectable white brow snake venom hemagglutinase to stop the bleeding and other symptomatic treatments.
III. Treatment effect
After surgery, the patient’s uterus and fallopian tubes were removed and she was followed up in the outpatient clinic for 3 months. During the follow-up consultation, we learned that the patient’s discomfort such as frequent urination and abdominal cramping had improved. However, since the patient lost her uterus after treatment, she would not have menstrual periods in the future and her symptoms of increased menstrual flow improved naturally. A repeat ultrasound examination revealed no other abnormalities, indicating that the patient’s treatment was effective.
IV. Precautions
Although the patient’s uterus and bilateral fallopian tubes were removed after treatment, it is gratifying that the patient was cured of multiple uterine fibroids. After the patient is cured and discharged from the hospital, she needs to pay attention to avoid increasing abdominal pressure movements, such as deep squatting, sit-ups, coughing, etc. In terms of diet, it is recommended to enhance nutrition and eat more vegetables and fruits rich in vitamins and fiber to prevent constipation. At the same time, patients should continue to take oral polysaccharide iron complex capsules to correct anemia. If sudden abnormalities such as heavy vaginal bleeding and fluid flow occur, promptly seek medical attention.
V. Personal insight
Uterine smooth muscle tumor is a benign tumor of the reproductive system, which has a high incidence, mostly in women of reproductive age, with a prevalence rate of about 25%. Uterine fibroids are mainly composed of uterine smooth muscle, connective tissue and glands, and can occur in the intermural, submucosal or subplasma, with different sizes and numbers.
For the treatment of fibroids, surgery is usually chosen, but due to the different fertility requirements of each individual, there are conservative surgery and radical resection surgery. Patients with fertility requirements generally choose conservative surgery, while patients who are older and do not have fertility requirements can choose radical surgery, so in this case the patient can choose radical hysterectomy.