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Re: Prolapsing myomaFrom: Bernard Cristalli (bclaure@club-internet.fr)Wed Jan 29 00:02:27 1997
Richard M. Chudacoff, MD wrote: > > I have an interesting patient that I need your help with. 33 yo G6 P4 > 2Ab, s/p BTL '93, with a large, necotic prolapsing fibroid, appx 5 cm in > diameter. … > > My thought is to give Depro-Lupron, shrink the fibroid, and put her on > iron, to increase her blood count, then do a TAH, possible LSO versus > cystectomy, in 3 months. I don't think she has cervical Ca, but cannot > rule this out completely. What would you do? Exam under anesthesia, > with a biopsy of the mass? Straight to the OR? Patient seems reliable, > contrary to the above history. > The initial problem seems to be the prolapsing fibroid (we say fibrome accouche par le col = delivered through the cervix). It can be removed during a simple exam through bistournage (pulling & twisting). If you think it can bleed you can try to tie a knot on the fibroid's implantation site under anesthesia. For the rest TAH after irontherapy. But if she's relable & smart & OK with it you can perform the TAH at once.
-- Bernard Cristalli MD CNGOF Paris - France
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