Asma Gul, Fehmida Naheed.
Vaginal Myomectomy.
J Coll Physicians Surg Pak Jan ;10(4):151-2.

This is a case report of vaginal myomectomy in a woman aged 35 years, married for 10 years, having no issue, presented with excessive cyclical bleeding for the past two years followed by irregular bleeding, lower abdominal pain and backache for the last one year and feeling of mass in lower abdomen since six months. On abdominal examination, a mass corresponding to 18-20 weeks size of pregnancy was found. Speculum examination showed a leiomyomatous cervical polyp of 8 x 9 cms with wide base. Her vaginal myomectomy was performed in piecemeal.

CASE REPORT: A 35 years old woman, married for 10years, having no issue was referred from gynaecological out-patient Department of Lahore General Hospital, Lahore, with the complaints of excessive cyclical bleeding since last two years followed by irregular bleeding for the last one year, in between period of bleeding she complained of yellowish vaginal discharge.Along with bleeding, she had pain in lower abdomen and backache for one year. Previously, she had normal regular cycle. She also had feeling of mass in lower abdomen for six months which was gradually increasing in size. There was history of increased frequency of micturation, no history of urinary incontinence or urinary retention. Her past medical and surgical history was not significant. Her husband was a labourer and she was a housewife. On examination, she was pale looking woman of average height and built. Her vital signs were normal, thyroid was not palpable and lymph nodes were not enlarged. On systemic examination no positive findings were detected however, on abdominal examination, it was soft, uterus corresponded to 18-20 weeks size of pregnancy, firm in consistency, mobile, without any tenderness. On speculum examination there was a leiomyomatous polyp of about 8 x9 cms size with wide base, filling whole of vagina. On bimanual examination cervical as was 5 cms dilated, sessile polyp was protruding through the right cervical lip, uterus was of 18-20 weeks size of pregnancy, mobile and fornices were clear.On investigations, her hemoglobin was 7.6 gm %, urine analysis, blood sugar level and renal function tests were normal. Abdominal ultrasound confirmed submucous leiomyoma occupying the uterine cavity and projecting in vagina. Hemoglobin level was improved by transfusing three units of fresh blood, 2 units of blood were kept arranged for surgery. Pre-operative antibiotics were started. Vaginal myomectomy was planned as the tumour was arising from the cervix and 3 extending into endometrial canal and vagina. The tumour was removed piecemeal. The base of the leiomyoma on right side of external cervical as was tied and stitched. The duration of operation was 45 minutes and average blood loss was 300m1.The specimen was sent for histopathology which revealed leiomyoma. The patient was discharged on third postoperative day. She was re-examined after 3 weeks when she was looking perfectly well. She had no complaint. Speculum examination showed normal looking cervix. Bimanual examination revealed bulky size uterus and clear fornices. She was seen monthly. She had regular menstrual cycle with normal flow and no dysmenorrhoea. After six months, she was referred to infertility clinic for her infertility workup.

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