What is Necrosis of the Myomatous Node?
Uterine fibroids are the most common benign tumor of the internal genital organs. Necrosis of myomatous nodes occurs in approximately 7% of patients with uterine myoma, often during pregnancy, in the postpartum or postabortion period.
Causes of Necrosis of the Myomatous Node
Necrosis of the myomatous node can be associated either with the torsion of its legs during subserous localization, or with insufficient vascularization. During pregnancy, prerequisites are created for necrosis of the myomatous nodes: a decrease in blood flow in the myometrium with an increase in vascular tone and a violation of the venous outflow. You should also take into account the rapid increase in myomatous nodes in parallel with the growth of a pregnant uterus. Necrosis is accompanied by the development of edema, hemorrhages, aseptic inflammation in the node. With the progression of the disease, peritonitis may develop.
Symptoms of Myomatous Necrosis
When the legs of the myomatous node are twisted, the disease develops acutely – there are cramping pains in the lower abdomen, nausea, vomiting, chills, dry mouth, intestinal function is impaired. With insufficient blood supply (malnutrition) of the myomatous node, the clinical picture is more blurry, the symptoms appear gradually. The patient is disturbed by pulling pains in the lower abdomen and lower back, they periodically intensify, weaken or disappear. At the time of an attack of pain, there may also be nausea, chills, fever, usually to subfebrile values, tachycardia.
Diagnosis of Necrosis of the Myomatous Node
Diagnosis of torsion of the leg or malnutrition of the myomatous node is based on anamnesis with an indication of uterine fibroids, complaints, clinical manifestations. On physical examination, there may be pallor of the skin, a dry, coated tongue. The abdomen is swollen, tense, palpation painful in the lower sections, positive symptoms of peritoneal irritation are also determined there. Gynecological examination allows you to identify an enlarged, myomatous changed uterus, painful at the site of necrosis of the myomatous node. Sometimes it is not possible to distinguish a subserous myomatous node from an ovarian tumor. In peripheral blood leukocytosis, an increase in ESR are detected. Of the additional non-invasive research methods, ultrasound scanning of the pelvic organs is important, in which the signs of malnutrition in the myomatous node are determined (decrease and heterogeneity of echographic density, the appearance of fluid cavities in the node). An informative diagnostic method is laparoscopy. With a visual examination of the pelvic organs, you can determine an enlarged myomatous uterus with torsion of the legs and signs of necrosis (edema, hemorrhage, cyanotic-crimson color) of the subserous node.
Treatment of Necrosis of the Myomatous Node
Treatment for torsion of the legs of the subserous myomatous node consists in emergency surgery. The volume of surgical intervention depends mainly on the severity of necrotic changes in the node, the involvement of the peritoneum in the pathological process (signs of peritonitis), the age of the patient. In girls, women of reproductive age, as well as in pregnant women with necrosis of the myomatous node without peritonitis, organ-preserving operations should be sought, limited to conservative myomectomy. In patients in pre- and postmenopause, supravaginal amputation or hysterectomy is performed.
In case of malnutrition of the myomatous node, emergency care begins with infusion therapy to reduce intoxication and normalize the water-electrolyte balance. Use tools that improve microcirculation, antispasmodics and anti-inflammatory drugs. The effectiveness of conservative treatment is assessed within the next 24-48 hours. If the condition worsens, the symptoms worsen, the conservative therapy is ineffective or signs of peritonitis appear, an emergency operation is indicated. The volume of surgical intervention is determined individually depending on the changes identified in a two-handed study.