Management of an infected prolapsed pedunculated submucosal leiomyoma in a postmenopausal woman: a case report

The prolapse of fibroids is a rare complication of pedunculated submucosal uterine fibroids. Affected patients may experience lower abdominal pain, a sensation of a mass in the vagina, foul-smelling vaginal discharge, vaginal bleeding, and unmet social needs. We present a rare case of infected prolapsed pedunculated submucosal uterine fibroids in a postmenopausal woman. A 58-year-old woman, para 6 (all alive) with 1 spontaneous abortion, presented with a 3-week history of lower abdominal pain. She also complained of a sensation of a mass protruding through her vagina, accompanied by foul-smelling vaginal discharge and an inability to void urine. The patient was generally stable, and the systemic examination was unremarkable. Pelvic examination revealed a protruding ill-defined mass with offensive vaginal discharge. Full blood count, liver and renal function tests, and chest X-ray investigations were unremarkable. However, an abdominopelvic ultrasound revealed a cervical mass. Pelvic examination under anaesthesia revealed a prolapsed uterine myoma with necrosis and foul odour. Intravenous ceftriaxone and paracetamol were administered, and total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The postoperative condition was stable. The patient was subsequently transfused with a unit of whole blood, administered intravenous clindamycin and gentamicin, and discharged on postoperative day 6 on oral cefixime and clindamycin. Pedunculated uterine myoma prolapse is rare and can have both physical and psychosocial consequences. This case highlights the importance of prompt diagnosis, surgical management, infection control, and attention to psychosocial well-being in women with infected fibroids.