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Journal of Postgraduate Medicine, Vol. 50, No. 1, January-March, 2004, pp. 80 Letter To Editor Uterine restoration following fibroid expulsion after uterine artery embolisation using gelfoam Gulati MS, Srinivasan A, Paul SB, Bhatla N Departments of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi Code Number: jp04010 Sir, We have been using uterine artery embolisation routinely at our centre for the last two years to treat selected symptomatic patients with fibroids. We report a case of a 35-year-old woman who presented with menorrhagia and dysmenorrhoea with a uterus measuring 5.9 cm in diameter, as seen on transabdominal ultrasound and MR imaging. The patient underwent bilateral uterine artery embolisation using a single 5 F Uterine Artery Catheter (Cook, Bloomington, IN, USA) from the right transfemoral route using standard technique.[1] Instead of using polyvinyl alcohol particles we used gel foam particles as detailed in the article by Katsumori et al.[2] Embolisation of both uterine arteries was effected to the point of near occlusion of the uterine arteries and the uterine vascular bed with reflux of contrast into the arch segment and the descending parts of the uterine arteries. Post-embolisation crampy abdominal pain was effectively controlled using intravenous infusion of a combination of pentazocine and midazolam which continued for two days following the procedure. Following the procedure, the patient′s symptoms of menorrhagia and dysmenorrhoea improved in the first menstrual cycle itself. Three months following the procedure, the patient reported painless evacuation of a fleshy mass per vaginum on the first day of her menstrual period. Ultrasound revealed a normal uterus with complete disappearance of the fibroid. It was speculated that the fibroid must have been expelled with complete restoration of the uterus. The patient has been asymptomatic since this episode for the last one year. Uterine artery embolisation has been tried as an alternative to surgery and has proved successful in treating symptomatic fibroids.[1]-[3] Permanent embolisation particles (such as polyvinyl alcohol) are usually injected into uterine arteries to obtain fibroid shrinkage. Results of fibroid embolisation have been very encouraging. In the study by Klein et al,[3] 92% patients were satisfied with the reduction of bleeding, and 78% were satisfied with the reduction in pressure symptoms. The mean decrease in uterine volume was 36%, and the mean decrease in the size of the dominant fibroid was 49%. Most of the shrinkage of the fibroid occurs within a 6-month period with further reduction occurring between 6-12 months. A few studies have reported expulsion of the fibroid following embolisation, as happened in our case.[4],[5] There has, however, been only one report in English literature so far, of complete uterine restoration following expulsion of the fibroid,[5] which was reported following the use of polyvinyl alcohol particles, with complete cessation of symptoms thereafter. Our case became totally asymptomatic and had painless expulsion of the fibroid three months following embolisation and is unique because it followed embolisation using gel foam particles, which are very economical and yet highly effective embolisation materials as recently reported.[2] References
Copyright 2004 - Journal of Postgraduate Medicine |
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