TITLE:
Uterine Fibromyoma and Intravascular Thrombosis—Eight Cases
AUTHORS:
Pratibha Devabhaktuni, Prem C. Gupta, Somaraju Bhupatiraju, Balamba Puranam, Saleem M. Abdul
KEYWORDS:
Fibroid; Leiomyoma; DVT; Intravascular Thrombosis; IVL; Intravenous Leiomyomatosis; PTE
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.4 No.4,
March
10,
2014
ABSTRACT: Objectives: We present
eight cases of vascular thrombosis of the pelvic vessels and deep venous
thrombosis (DVT) of the lower limb, secondary to compression of the pelvic
vessels by the uterine fibroid, managed over a span of twelve years from 2001
to 2013. We discuss the mean size of the leiomyoma, the prediliction for DVT of
the left lower limb, the role of oral contraceptives when used in women with
large fibroids, to increase the risk of DVT and present a brief literature
review.Results:Age,the mean age of our patients was—41.12
yrs, range—18 yrs to 50 yrs.Parity and Menopausal Status: Seven were
parous women. One was unmarried, nulligravid.Seven were premenopausal and
one was postmenopausal.Vascular Thrombosis:In one it was arterial
thrombosis and in seven it was venous thrombosis.DVT was on the left side
in -6/8-75%. Clinical Complaints:The presenting
complaints were heavy menstrual bleeding in three,severe dysmenorrhoea
and heavy bleeding in one,mass per abdomen in one, heavy menses and
abdominal mass in one, no complaints apart from DVT in one.Uterine
Enlargement:The size of the uterus was between 12 to 26 weeks. The mean
size was 20 weeks.It was a single fibromyoma in six and multiple, two in
two.Use of Oral Contraceptives:OC pills were used to control heavy
menstrual bleeding in three cases—3/8, 37.5%.Discussion:The DVT was
on the left side in six of our cases,75% were on the left side in our
series. Menstrual problems like heavy bleeding can be secondary to fibromyoma.
Three of the eight—37.5%,women used OC pills to control menorrhagia. One
developed DVT after one cycle of use of OC pills;the second developed
arterial thrombosis of the pelvic vessels after four cycles of OC pill use;the
third used OC pills for a longer period, on and off. The woman who developed
arterial thrombosis was using OC pills with 50 mcgs of oestrogen and 0.5 mg
norgestrel. Conclusions: Uterine leiomyoma can cause vascular thrombosis
secondary to compression of the pelvic vessels. The mean size of the uterine
enlargement by the fibromyoma was 20 weeks and in 6/8, it was a solitary
fibromyoma. DVT was on the left side in 75% of our cases. Use of OC pills in
women with an enlarged uterus with leiomyoma can increase the risk of DVT.