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LETTER TO EDITOR
Year : 2004  |  Volume : 50  |  Issue : 1  |  Page : 80

Uterine restoration following fibroid expulsion after uterine artery embolisation using gelfoam


1 Departments of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
2 Departments of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
M S Gulati
Departments of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


PMID: 15048010

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How to cite this article:
Gulati M S, Srinivasan A, Paul S B, Bhatla N. Uterine restoration following fibroid expulsion after uterine artery embolisation using gelfoam. J Postgrad Med 2004;50:80

How to cite this URL:
Gulati M S, Srinivasan A, Paul S B, Bhatla N. Uterine restoration following fibroid expulsion after uterine artery embolisation using gelfoam. J Postgrad Med [serial online] 2004 [cited 2019 Nov 15];50:80. Available from: http://www.jpgmonline.com/text.asp?2004/50/1/80/6664


Sir,

We have been using uterine artery embolisation routinely at our centre for the last two years to treat selected symptomatic patients with fibroids. We report a case of a 35-year-old woman who presented with menorrhagia and dysmenorrhoea with a uterus measuring 5.9 cm in diameter, as seen on transabdominal ultrasound and MR imaging. The patient underwent bilateral uterine artery embolisation using a single 5 F Uterine Artery Catheter (Cook, Bloomington, IN, USA) from the right transfemoral route using standard technique.[1] Instead of using polyvinyl alcohol particles we used gel foam particles as detailed in the article by Katsumori et al.[2] Embolisation of both uterine arteries was effected to the point of near occlusion of the uterine arteries and the uterine vascular bed with reflux of contrast into the arch segment and the descending parts of the uterine arteries. Post-embolisation crampy abdominal pain was effectively controlled using intravenous infusion of a combination of pentazocine and midazolam which continued for two days following the procedure.



Following the procedure, the patient′s symptoms of menorrhagia and dysmenorrhoea improved in the first menstrual cycle itself. Three months following the procedure, the patient reported painless evacuation of a fleshy mass per vaginum on the first day of her menstrual period. Ultrasound revealed a normal uterus with complete disappearance of the fibroid. It was speculated that the fibroid must have been expelled with complete restoration of the uterus. The patient has been asymptomatic since this episode for the last one year.



Uterine artery embolisation has been tried as an alternative to surgery and has proved successful in treating symptomatic fibroids.[1]-[3] Permanent embolisation particles (such as polyvinyl alcohol) are usually injected into uterine arteries to obtain fibroid shrinkage. Results of fibroid embolisation have been very encouraging. In the study by Klein et al,[3] 92% patients were satisfied with the reduction of bleeding, and 78% were satisfied with the reduction in pressure symptoms. The mean decrease in uterine volume was 36%, and the mean decrease in the size of the dominant fibroid was 49%. Most of the shrinkage of the fibroid occurs within a 6-month period with further reduction occurring between 6-12 months. A few studies have reported expulsion of the fibroid following embolisation, as happened in our case.[4],[5] There has, however, been only one report in English literature so far, of complete uterine restoration following expulsion of the fibroid,[5] which was reported following the use of polyvinyl alcohol particles, with complete cessation of symptoms thereafter. Our case became totally asymptomatic and had painless expulsion of the fibroid three months following embolisation and is unique because it followed embolisation using gel foam particles, which are very economical and yet highly effective embolisation materials as recently reported.[2]

 
 :: References Top

1.Bradley EA, Reidy JF, Forman RG, Jaosz J, Braude PR. Transcatheter uterine artery embolisation to treat large uterine fibroids. Br J Obstet Gynaecol 1998;105:235-40.  Back to cited text no. 1    
2.Katsumori T, Nakajima K, Mihara T, Tokuhiro M. Uterine artery embolisation using gelatin sponge particles alone for symptomatic uterine fibroids:Midterm results. AJR 2002;178:135-9.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Klein A, Schwartz ML. Uterine artery embolisation for the treatment of uterine fibroids:An outpatient procedure. Am J Ob Gyn 2001;184:1556-63.  Back to cited text no. 3    
4.Berkowitz RP, Hutchins Jr FL, Worthington-Kirsch RL. Vaginal expulsion of submucosal fibroids after uterine artery embolisation;a report of 3 cases. J Reprod Med 1999;44:373-6.  Back to cited text no. 4    
5.Felemben A, Stein L, Tulandi T. Uterine restoration after repeated expulsion of myomas after uterine artery embolization. J Am Assoc Gynecol Laparosc 2001;8:442-4.  Back to cited text no. 5    



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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow