In Reply to: Re: Case 0100_03 -- Fibroid Expulsion in Progress posted by George A. Fueredi on January 03, 19100 at 23:02:10:
We've discussed this kind of event in this forum before.
I have a low threshold for sending patients for hysteroscopy/D&E when they develop the symptoms that we now recognize as indicating a sloughing myoma - return of crampy pain and development of a foul-smelling discharge. Those patients who have had both experiences say that it is similar to having a miscarriage.
Sloughing a myoma appears to occur in about 5-10% of patients. It has occurred as rapidly as a few days after UAE and as late as several months post-procedure (in the November case club someone mentioned that one of his patients had sloughed a myoma 17 months after UAE).
I start all patients on oral antibiotics as soon as they call me, and refer them to gyn for evacuation of the uterine contents if the myoma hasn't passed (with resolution of symptoms) within 24-48 hours.
From discussions with others, I think that many of the patients who developed a late infection requiring hysterectomy were patients who had these kind of symptoms and were watched rather than having their uterine cavities evacuated. I have one patient who did not seek medical care despite having such a discharge for several months, and ended up having an hysterectomy (at another hospital) with a diagnosis of "chronic endometritis".
As I tell patients, when they slough a fibroid (whether it passes spontaneously or needs to be evacuated) the experience can be unpleasant for a few days. However, this is often associated with sudden and marked decrease in uterine size adn imptrovement in bulk-related symptoms. I regard this as a postiive outcome of UAE, so long as it is properly managed and time is not given for the necrotic myoma to become superinfected.