An unusual presentation of a fibroid uterus and unusual indication for its removal

Februrary 10, 2011

Dr. Rahul Manchanda

Dr. Pratibha Garg

Mrs. Jain came from Bombay with an ultrasound report of a fibroid uterus. Her main complaint was a watery discharge from below which had increased over the year from slight to now a constant and copious discharge throughout the day for which she needed to wear a pad/diaper always. She did have associated heavy bleeding during her periods for which she rested during the period to avoid excessive blood loss, this though was not considered important by her and her over riding complaint was the discharge. A preliminary examination showed a watery clear fluid ala urine coming in fairly decent amount in the vagina. This tested though did not show any urea content like urine and Mrs. Jain had had no previous known surgical intervention. On palpating her tummy she had a huge mass the size of an 18-20week uterus which was mobile. This along with the ultrasound report and a provisional diagnosis of huge fibroid uterus was made and her family being completed she was advised a laparoscopic hysterectomy which was done on 10/2/11. The mass was morcellated and taken out. Recovery was uneventful and she was discharged on the second post operative day and she did very well and stitches were removed on the 7th day, her complaints/symptoms having abated. Discussion 1) Degenerating fibroids with necrosis can lead to a discharge per vaginum but this is usually thick, dirty and can be infected. 2) Clear copious urine like discharge is uncommon and can masquerade misleadingly as incontinence. A simple examination of the fluid for urea will clear the doubt. 3) Incontinence of urine, frequency, pain, constipation and other pressure symptoms are generally the norm in huge pelvic masses like fibroids, which in our patient were actually absent. 4) Huge fibroid uteruses can be removed laparoscopically and patients do well thereafter in all respects, what is most pleasing to see is the extremely shortened recovery time. 5) When the specimen is sent in a morcellated heap then one should mark or tag the various parts like cervix as it is extremely difficult for the pathologist to identify the cervix later and at time nigh impossible despite taking multiple and many sections!