Pedunculated Fibroid

Pedunculated fibroids are non-cancerous uterine growths attached to the uterine wall by a peduncle, a stalk-like growth. Those that grow inside the uterus are known as pedunculated submucosal fibroids, and those that develop outside the uterus are known as subserous pedunculated fibroids.

Pedunculated fibroids can become quite large. An article in the East African Medical Journal last year reported that a 37-year-old woman presented with significant, increasing abdominal swelling. Surgeons removed a 1.5 kg pedunculated fibroid that was almost 16 cm in length.

But this woman did not have any other symptom expect swelling. But many are not so lucky with their pedunculated fibroids.

These sub-mucosal fibroid sometimes obtrude into the vaginal canal and causes pain during intercourse. The American University of Beirut Medical centre diagnosed two women with prolapsed pedunculated sub-mucosal fibroids and for another woman 12 centimeters of this fibroid had prolapsed partly into the vaginal canal and uterus.

When the stalk gets distorted it causes severe pain but very few faces this problem. It is very risk if the fibroid in the stalk grows.

Other painful symptoms that are often associated with these fibroids are uterine cramps, as well as pressure on the uterus along with other organs.

Some women with pedunculated submucosal fibroids experience light to moderate bleeding throughout their menstrual cycles. Those women who experience continuous bleeding usually see an increase in bleeding during the time of their regular period.

If a pedunculated fibroid becomes twisted, the patient may need emergency surgery. The pain of a twisted peduncle can be so excruciating that the patient requests any possible procedure to alleviate it.

A twisted peduncle can also create a blockage in the veins that deliver blood and nutrients to the growth. When the blood and nutrients are cut off, the fibroid begins to weaken. As the fibroid deteriorates, the pain increases greatly, as does the risk of infection.

When a peduncle is determined to be 2cm or more in width, a process called Uterine Artery Embolization is indicated. This procedure blocks the blood supply to the growths so that they begin to deteriorate and eventually die. This procedure has been found to be more successful with subserousal fibroids than with any other kind of fibroid.

Doctors at the Bretonneau Hospital in France have found that up to 10% of patients who undergo Uterine Artery Embolization for pedunculated fibroids encounter regrowth of their fibroids after 2 years. For this reason, they recommend that the procedure be repeated after 2 years.

Another similar procedure for pedunculated fibroids is Myomectomy. This method is done to remove the fibroid but it is not 100% success and sometimes repairs the uterus. The University of South Dakota diagnosed a patient with bigger fibroid, in which the blood vessel has been ruptured after she gave birth. Since their attempt on Myomectomy failed, an immediate hysterectomy was done.

Often prior to a myomectomy the woman is required to sign an agreement to allow a hysterectomy to be performed should anything go wrong during the procedure, so women that undergo this procedure sometimes wake up without a uterus.