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Case Reports
. 2021 Feb 12;21(1):132.
doi: 10.1186/s12884-021-03619-6.

Prolapsed submucosal pyomyoma postpartum, a rare complication of fibroids

Jingxue Wang #  1 , Zheng Li #  1 , Yu Sun  2
Affiliations
Case Reports

Prolapsed submucosal pyomyoma postpartum, a rare complication of fibroids

Jingxue Wang et al. BMC Pregnancy Childbirth. .

Abstract

Background: Pyomyoma is an unusual fibroid that usually develops during the puerperal or postmenopausal period. If not promptly diagnosed and treated, it can become life threatening. Although various conservative and surgical therapies have been discussed in the literature for this condition, there are very few reports related to the management of prolapsed pedunculated submucosal myoma.

Case presentation: In this case report, an intramural fibroid transformed into a pedunculated submucosal pyomyoma, which prolapsed into the vagina after a miscarriage and caused life-threatening toxic shock. Apart from prompt antibiotic treatment, a transabdominal myomectomy rather than hysterectomy was performed due to the very large diameter of the pyomyoma. As a result, fertility was preserved, and the patient conceived naturally and delivered a healthy baby two years later.

Discussion and conclusions: It is important to maintain strong clinical suspicion for pregnant or postpartum women with a triad of pain, sepsis without an obvious source and a known diagnosis of leiomyoma. Timely recognition and prompt surgical treatment with antibiotics are necessary and could conserve the uterus for future fertility.

Keywords: Case report; Postpartum; Pyomyoma; sepsis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Ultrasound examinations of the fibroids during pregnancy. a Ultrasound showing an intrauterine pregnancy and an intramural posterior fundal fibroid; b Ultrasound of the original fibroid and two additional fundal fibroids; c Large posterior wall fibroid pushing the endometrium anteriorly; d Cross-section through the three submucosal myomas. The areas filled with fluid demonstrated a hyperechogenic pattern, which indicated the possibility of degeneration and necrosis
Fig. 2
Fig. 2
MRI examinations and grossspecimens of the submucous pyomyoma postpartum. a and b Coronal and horizontal MRI showing abnormal signals in the uterine cavity, suggestive of necrotic tissue. c and d Fibroid after removal
See this image and copyright information in PMC

References

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