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GYN: fibroids/future fertilityFrom: Garry E. Siegel, M.D. (garrys@mindspring.com)Thu Feb 26 16:34:46 1998
I would love some input, especially from the big boy REIs! 31 YO seen for mildly painful periods, on no contra, regular periods, negative history, posterior uterus ?irregular. My impression was r/o endo versus fibroids. Since she did not want the pill (she is contemplating pregnancy this summer), I gave her the usual speech about dysmenorrhea, endo, etc., and she decided that she wanted to have scopes done. If I had an ultrasound done, I can't remember it; I think I didn't, for some reason. Anyway, she was found to be markedly anemic (Hct 25) at preop, so the surgery was postponed from 12/97 until she could be worked up (Fe deficiency) and corrected. Today, she had an irregular fibroid uterus at exam under anesthesia, a large (3 or 4 cm) fibroid that filled most of the uterine cavity at hysteroscopy, and several large intramural and subserosal fibroids from 2 to 5 cm distorting the uterus. She had one spot of endo over the right ureter on the sidewall, and gelatinous goop reminiscent of old PID hanging from both ovaries, which were otherwise ok (no endo). There was minimal adhesive disease between the ovaries and the ovarian fossae, easily broken up with flipping the ovaries, and one tube easily filled and spilled (the right), and the left was occluded distally with clubbing. Incidentally, I could see only the left tubal ostium by hysteroscope. So, she needs an open myomectomy, I think, and a goop cleanup at the same time, as she wishes pregnancy this summer. What should I do, if anything, with the clubbed tube? Garry
-- Garry E. Siegel, M.D., FACOG Private Practice Roswell, Ga.
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