Location
Moultrie, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
Introduction: Uterine leiomyomas are common benign tumors, with a 70–80% prevalence among women of reproductive age. While many are asymptomatic, larger fibroids can cause pelvic pressure, abnormal bleeding, anemia, and organ compression. Rarely, leiomyomas prolapse through the cervical canal, causing complex distortions and surgical challenges. Management depends on symptoms, size, location, and reproductive goals. For women wishing to preserve fertility, myomectomy is preferred. This case report details the surgical management of a large prolapsing leiomyoma and highlights key intraoperative considerations treatment.
Methods: This study was conducted as a case report supplemented by a structured review of current scientific literature. Relevant articles addressing the diagnosis and surgical management of uterine fibroids were identified through database searches including PubMed, Cochrane Library, and Google Scholar via the Philadelphia College of Osteopathic Medicine (PCOM) online library. Priority was given to recent systematic reviews, randomized controlled trials, and clinical guidelines. Clinical data for the present case were obtained from the patient’s medical record, including imaging findings, operative documentation, and postoperative outcomes course.
Results: A 38-year-old woman with a history of iron deficiency anemia presented with pelvic discomfort and a known uterine mass. Pelvic imaging showed a large mass consistent with a uterine leiomyoma measuring approximately 14 × 10.1 × 7.1 cm on transvaginal ultrasound. MRI confirmed a large fibroid prolapsing through the cervix into the upper vagina, causing significant distortion of the endometrial canal. The uterus was markedly enlarged and extended to the level of the umbilicus. Given the patient’s reproductive age and desire to preserve her uterus, she underwent surgical management with an open abdominal myomectomy. Intraoperatively, the fibroid was palpated within the enlarged uterus and was seen to extend through the endometrial cavity and cervical canal. After injecting vasopressin to minimize intraoperative bleeding, the uterine serosa was incised, and a clear surgical plane was identified. The leiomyoma was carefully dissected and removed from its myometrial attachments. Due to the size of the defect and the distortion of uterine architecture, multilayer reconstruction of the endometrial cavity and myometrium was performed with absorbable sutures. An amnion graft and hemostatic sealant were applied to promote tissue healing and control bleeding. The patient tolerated the procedure well and was transferred to recovery in stable condition without intraoperative complications.
Discussion: Large prolapsing uterine leiomyomas are an uncommon but surgically significant presentation of fibroid disease. These growths can alter normal uterine structure and complicate surgical planning, especially when preserving fertility is a priority. Careful preoperative imaging is crucial for planning and understanding the relationship between the fibroid, endometrial cavity, and surrounding structures. In carefully chosen patients, myomectomy remains a safe and effective option for preserving the uterus, even with large fibroids. This case shows that meticulous surgical technique can successfully remove large leiomyomas while keeping the uterus intact and potentially preserving reproductive function.
Embargo Period
5-27-2026
Included in
Surgical management of an unusually large uterine leiomyoma with cervical dilation in a reproductive-age woman
Moultrie, GA
Introduction: Uterine leiomyomas are common benign tumors, with a 70–80% prevalence among women of reproductive age. While many are asymptomatic, larger fibroids can cause pelvic pressure, abnormal bleeding, anemia, and organ compression. Rarely, leiomyomas prolapse through the cervical canal, causing complex distortions and surgical challenges. Management depends on symptoms, size, location, and reproductive goals. For women wishing to preserve fertility, myomectomy is preferred. This case report details the surgical management of a large prolapsing leiomyoma and highlights key intraoperative considerations treatment.
Methods: This study was conducted as a case report supplemented by a structured review of current scientific literature. Relevant articles addressing the diagnosis and surgical management of uterine fibroids were identified through database searches including PubMed, Cochrane Library, and Google Scholar via the Philadelphia College of Osteopathic Medicine (PCOM) online library. Priority was given to recent systematic reviews, randomized controlled trials, and clinical guidelines. Clinical data for the present case were obtained from the patient’s medical record, including imaging findings, operative documentation, and postoperative outcomes course.
Results: A 38-year-old woman with a history of iron deficiency anemia presented with pelvic discomfort and a known uterine mass. Pelvic imaging showed a large mass consistent with a uterine leiomyoma measuring approximately 14 × 10.1 × 7.1 cm on transvaginal ultrasound. MRI confirmed a large fibroid prolapsing through the cervix into the upper vagina, causing significant distortion of the endometrial canal. The uterus was markedly enlarged and extended to the level of the umbilicus. Given the patient’s reproductive age and desire to preserve her uterus, she underwent surgical management with an open abdominal myomectomy. Intraoperatively, the fibroid was palpated within the enlarged uterus and was seen to extend through the endometrial cavity and cervical canal. After injecting vasopressin to minimize intraoperative bleeding, the uterine serosa was incised, and a clear surgical plane was identified. The leiomyoma was carefully dissected and removed from its myometrial attachments. Due to the size of the defect and the distortion of uterine architecture, multilayer reconstruction of the endometrial cavity and myometrium was performed with absorbable sutures. An amnion graft and hemostatic sealant were applied to promote tissue healing and control bleeding. The patient tolerated the procedure well and was transferred to recovery in stable condition without intraoperative complications.
Discussion: Large prolapsing uterine leiomyomas are an uncommon but surgically significant presentation of fibroid disease. These growths can alter normal uterine structure and complicate surgical planning, especially when preserving fertility is a priority. Careful preoperative imaging is crucial for planning and understanding the relationship between the fibroid, endometrial cavity, and surrounding structures. In carefully chosen patients, myomectomy remains a safe and effective option for preserving the uterus, even with large fibroids. This case shows that meticulous surgical technique can successfully remove large leiomyomas while keeping the uterus intact and potentially preserving reproductive function.