Necrosis of the myomatous node is a complication detected during a disease such as uterine fibroids. A myomatous node is a benign tumor of the muscular layer of the uterus. Its necrosis is associated with a violation of the formation of blood vessels and nutrition. As a result, the tumor tissue undergoes irreversible changes, that is, it becomes dead. According to statistics, about seven percent of women with uterine fibroids face this phenomenon.
The content of the article:
Types of myomatous node necrosis
Causes of myomatous node necrosis
Symptoms of myomatic node necrosis
Diagnosis of myomatous node necrosis
Treatment of myomatous node necrosis
Prognosis for necrosis of the myomatous node
Prevention of necrosis of the myomatous node
Necrosis of the myomatous node
Necrosis of the myomatous node can occur with the following types of fibroids:
subserous (develops on the outside of the organ towards the pelvic cavity);
submucous (protrudes beyond the organ cavity);
intramural (localized in the middle muscle layer).
Signs are found in the affected tissues:
edema;
aseptic inflammation;
hemorrhages;
degeneration.
If the disease does not receive the necessary treatment, there is a significant threat of peritonitis (inflammation of the peritoneum).
Types of myomatous node necrosis
The types of necrosis of the myomatous node are distinguished by morphological features.
Coagulation (dry) necrosis of the myomatous node. The dead zones of the neoplasm shrink and form cavernous cavities, where fragments of necrotic tissues accumulate.
Wet necrosis of the myomatous node. Dead tissues soften and form cystic cavities.
Hemorrhagic infarction (red necrosis of the myomatous node). The node tissues acquire a soft consistency and a red-brown color. Accompanied by the expansion of the tumor veins and thrombosis. This type of disease is more common in pregnant women or women in labor.
Aseptic necrosis of the myomatous node. Necrosis of areas of the myomatic node is accompanied by infectious inflammation of hematogenic or lymphogenic nature. It can be caused by pathogens such as E. coli, Staphylococcus or Streptococcus. This type carries the maximum risk of peritonitis and sepsis.
Sometimes aseptic necrosis of the myomatous node is interpreted as a separate type of complication of uterine fibroids.
Causes of myomatous node necrosis
The fibroids that increase in size can provoke deformation of the vessels that feed it, or squeeze them. This happens most often for the following reasons:
twist the legs of the myomatous node;
inflection of the tumor leg;
node ischemia;
formation of blood clots in the myomatous node.
It is worth noting that the twisting of the leg is more typical for subserous fibroids, which for the most part have thin legs. Intramural tumors that are under the strong influence of contractions of the muscular layer of the uterus are more often subjected to ischemia. These reductions, in turn, can be caused by:
the use of drugs that affect the uterine muscles;
pregnancy;
childbirth.
In general, necrosis of the myomatous node is caused by a violation of blood flow in it.
Symptoms of myomatic node necrosis
A disease such as necrosis of the myomatous node shows the same symptoms, regardless of the type. They differ, rather, in the intensity of manifestation, depending on the nature of the occurrence:
in case of a violation of the blood supply — gradually;
when twisting the legs, it is acute.
In general , the symptoms of necrosis of the myomatous node are as follows:
pulling or cramping pains in the lower abdomen;
tension of the anterior abdominal wall;
temperature rise to 37.5 degrees;
chills;
tachycardia;
constipation, increased gas formation;
dry mouth;
nausea and vomiting;
soreness of the node or the entire uterus during gynecological palpation.
Against the background of pain attacks, the development of subfebrility is not excluded — a condition characterized by a constantly elevated body temperature about a degree above normal.
Diagnosis of myomatous node necrosis
The first stage of diagnosis in case of suspected necrosis of the myomatous node involves the collection of anamnesis and physical examination of the patient. The doctor pays attention to the following:
abdominal condition: a woman complains of bloating, positive peritoneal symptoms are observed in the lower parts, as well as soreness.
the condition of the skin: they differ in pale color.
condition of the tongue: overlaid with a whitish coating;
the state of the cardiovascular system: blood pressure is normal, but the patient complains of tachycardia.
The blood test contains the following signs indicating necrosis of the myomatous node:
increase in ESR;
increase in white blood cells;
left shift of the leukocyte formula.
Ultrasound of the pelvic organs is aimed at clarifying the following parameters:
increase in the size of the uterus;
the appearance of cystic cavities in the node;
reduced node density;
heterogeneity of the structure of the myomatous node;
changing the contours of the node.
In some cases, an increase in the size of the uterus is established during a gynecological examination.
Laparoscopy is often used to clarify the diagnosis. It allows you to establish the nuances of the course of the disease, which cannot be detected by other methods, for example, hemorrhage or swelling in the node. In addition, diagnostic laparoscopy prepares access for subsequent surgical intervention.
Treatment of myomatous node necrosis
There is only one method of treating necrosis of the myomatous node — surgical. As soon as the symptoms of this violation have been identified, the woman should immediately go to the hospital. Necrosis of the myomatous node cannot be cured on an outpatient basis. The choice of the operation option will depend on:
age of the patient;
whether she has successfully completed childbirth;
the number of myomatous nodes;
the size of each myomatous node;
node locations;
threats of peritonitis.
If a woman is young, is of reproductive age, has not yet given birth or is pregnant at the moment, she may be prescribed a conservative myomectomy. This operation consists in the removal of fibroids while preserving the uterus. After such a surgical intervention, the patient will be able to give birth to a child.
If a woman is on the verge of menopause, and her reproductive function has already been exhausted, there is no goal to save the organ. She can be removed:
the body of the uterus with the preservation of the cervix;
body and cervix;
the body and cervix, appendages and ovaries.
Depending on the complexity of the situation, the operation can be performed with laparoscopic or vaginal access.
It is possible to postpone the operation for a couple of days only in case of ischemia of the myomatous node. However, during these hours, the patient will need infusion therapy, which will normalize the water-electrolyte balance and ease the degree of intoxication.
Prognosis for necrosis of the myomatous node
Modern medicine gives a fairly favorable prognosis in case necrosis of the myomatous node was detected and eliminated in a timely manner. In addition, doctors try to preserve the childbearing function. However, after the operation, the patient should carefully monitor her condition.
The prognosis worsens in case of pathology progression. It can be peritonitis or blood poisoning, which, without proper medical care, lead to disastrous consequences, up to a fatal outcome.
Prevention of necrosis of the myomatous node
It is possible to prevent the development of necrosis of the myomatous node, first of all, by preventing the appearance of uterine fibroids. When fibroids have already appeared, it is impossible to postpone its treatment. In order to avoid complications, it is recommended to undergo preventive medical examination once a year. It includes a gynecological examination and ultrasound of the pelvic organs.
