In Reply to: Case 1199_05 -- Vaginal Expulsion of Fibroid After Uterine Artery Embolization posted by Editor on November 02, 1999 at 10:45:10:
1) Expulsion of a fibroid occuring after uterine artery embolization is uncommon, occuring in less than 5% of pts.
2) Patients who are expelling a fibroid should be managed aggressively. The reason for this is that the fibroid is necrotic and once the cervix begins to open, the necrotic tissue quickly becomes colonized. Many of the severe infectious complications that have been reported around the world were secondary to E. coli. In a patient who is beginning to expel a fibroid, if there is any evidence of infection at all, aggressive broad spectrum antibiotic therapy should be initiated. In addition, the patient may very well need a surgical procedure such as D & C to fully remove the necrotic tissue.
3) Patients who expel fibroids vaginally have submucosal fibroids as the culprit. In particular, a pedunculated fibroid is the most common fibroid that is expelled. A patient with pedunculated submucosal fibroids may be best served by myomectomy if the stalk can be excised hysteroscopically. If the patient has other transmural or subserosal fibroids causing symptoms, then she can go on to have embolization to address these additional fibroids at a later date once she is completely recovered from the myomectomy. If the stalk is not easily accessible or the patient refuses myomectomy, embolization can proceed. Embolization can be expected to have a good outcome in terms of infarcting the fibroid. However, both physicians of the patient need to be aware that further management may be needed when the fibroid is potentially expelled.