Pedunculated fibroids are non-cancerous uterine growths attached to the uterine wall by a peduncle, a stalk-like growth. Those that grow inside the uterus are known as pedunculated submucosal fibroids, and those that develop outside the uterus are known as subserous pedunculated fibroids.
Pedunculated fibroids can become quite large. An article in the East African Medical Journal last year reported that a 37-year-old woman presented with significant, increasing abdominal swelling. Surgeons removed a 1.5 kg pedunculated fibroid that was almost 16 cm in length.
But this woman did not have any other symptom expect swelling. But many are not so lucky with their pedunculated fibroids.
These sub-mucosal fibroid sometimes obtrude into the vaginal canal and causes pain during intercourse. The American University of Beirut Medical centre diagnosed two women with prolapsed pedunculated sub-mucosal fibroids and for another woman 12 centimeters of this fibroid had prolapsed partly into the vaginal canal and uterus.
Pedunculated fibroids can be painful, particularly if the peduncle becomes twisted. The risk of the peduncle twisting increases as the fibroid grows larger.
Other painful symptoms that are often associated with these fibroids are uterine cramps, as well as pressure on the uterus along with other organs.
This sub-mucosal fibroid even causes irregular bleeding during menstrual such as light spotting or regular bleeding all the time. Women with constant bleeding may undergo heavy bleeding during the menstrual cycle.
If a pedunculated fibroid becomes twisted, the patient may need emergency surgery. The pain of a twisted peduncle can be so excruciating that the patient requests any possible procedure to alleviate it.
Another possibility that can occur when the fibroid becomes twisted is a blockage in the blood and nutrient supply to the fibroid through a kink in the veins. Once this occurs the fibroid will begin to die, which will not only increase the danger of infection, but is also quite painful.
When a peduncle is determined to be 2cm or more in width, a process called Uterine Artery Embolization is indicated. This procedure blocks the blood supply to the growths so that they begin to deteriorate and eventually die. This procedure has been found to be more successful with subserousal fibroids than with any other kind of fibroid.
Doctors at the Bretonneau Hospital in France have found that up to 10% of patients who undergo Uterine Artery Embolization for pedunculated fibroids encounter regrowth of their fibroids after 2 years. For this reason, they recommend that the procedure be repeated after 2 years.
Another procedure often used to treat pedunculated fibroids is a myomectomy. In this procedure, the surgeon removes the fibroid and repairs the uterus. Myomectomy is not always 100% successful. In one case reported by the University of South Dakota, an unsuccessful myomectomy was performed, leading to an emergency hysterectomy for the patient.
Because the success rate for myomectomies is not 100%, women are usually asked to sign a waiver that specifies a hysterectomy if the surgery is not successful. Some women have gone in for one procedure and awakened after having two.