Uterine Fibromyoma and Intravascular Thrombosis—Eight Cases

Pratibha Devabhaktuni, Prem C. Gupta, Somaraju Bhupatiraju, Balamba Puranam, Saleem M. Abdul

Department of Cardiology, CARE Institute of Medical Sciences, Hyderabad, India.
Department of Obstetrics and Gynaecology, CARE Institute of Medical Sciences, Hyderabad, India.
Department of Surgery, CARE Institute of Medical Sciences, Hyderabad, India.
Department of Vascular Surgery, CARE Institute of Medical Sciences, Hyderabad, India.
Institute of Obstetrics and Gynaecology, Osmania Medical College, Hyderabad, India.

DOI: 10.4236/ojog.2014.44033                

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.

Keywords

Fibroid; Leiomyoma; DVT; Intravascular Thrombosis; IVL; Intravenous Leiomyomatosis; PTE

Conflicts of Interest

The authors declare no conflicts of interest.

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