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By Adrian Torres, BS; Sophia Mourad, BS; Andrew Dakkak, MD; and Nicholas Feranec, MD
History
A 29-year-old nulliparous woman with a history of polycystic ovary syndrome (PCOS) and a body mass index (BMI) of 69.7 presented with persistent, heavy vaginal bleeding for the past couple of months. Pelvic examination was deferred, due to the patient’s bodily habitus. A previously conducted transabdominal and transvaginal ultrasound reported a fibroid uterus on an extremely limited evaluation. A follow-up pelvic ultrasound was unable to be performed. The patient then underwent hemorrhagic shock and was treated with 11 units of packed red blood cells, one unit of platelets, one unit of fresh frozen plasma, and vasopressors. After being stabilized, the patient elected to undergo bilateral hypogastric artery embolization using Gelfoam, but the procedure was unsuccessful. Due to her persistent bleeding, the patient was then taken to the operating room to undergo endometrial myomectomy, but the procedure was aborted as there appeared to be a large prolapsing uterine mass in the vaginal introitus. Further workup with pelvic MRI was performed. A biopsy of the uterine mass was also scheduled. Continue reading »
History
A 29-year-old nulliparous woman with a history of polycystic ovary syndrome (PCOS) and a body mass index (BMI) of 69.7 presented with persistent, heavy vaginal bleeding for the past couple of months. Pelvic examination was deferred, due to the patient’s bodily habitus. A previously conducted transabdominal and transvaginal ultrasound reported a fibroid uterus on an extremely limited evaluation. A follow-up pelvic ultrasound was unable to be performed. The patient then underwent hemorrhagic shock and was treated with 11 units of packed red blood cells, one unit of platelets, one unit of fresh frozen plasma, and vasopressors. After being stabilized, the patient elected to undergo bilateral hypogastric artery embolization using Gelfoam, but the procedure was unsuccessful. Due to her persistent bleeding, the patient was then taken to the operating room to undergo endometrial myomectomy, but the procedure was aborted as there appeared to be a large prolapsing uterine mass in the vaginal introitus. Further workup with pelvic MRI was performed. A biopsy of the uterine mass was also scheduled. Continue reading »
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