Good afternoon. We are going to have a talk now about the largest fibroid we have ever removed, it seems like a movie topic, but we had already had surgeries weighing 2 kilos 850g, one of 3 kilos, a uterus with the fibroid weighing 3 kilos 900g… But this fibroid is the largest we have ever removed: 4 kilos, it didn’t bleed that much but the particular thing about this fibroid in addition to the size and weight was that the anatomy was intraligamentary, so let’s talk about these cases #SaberEsPower remember Creafam is with you .
She is a 45-year-old patient who, upon seeing one of the videos we uploaded, has already had a tumor weighing 2 kilos 800g, I believe, for a year. From that point on, she began to investigate. She was already about four or five years old and had diagnosed with a giant fibroid, but it scared him, from Oaxaca. She had gone to several doctors in Oaxaca, including some doctors we knew, and they had mentioned that they were going to remove her uterus and they only gave her a 30% chance of preserving the uterus. However, when I checked her, this patient did. It was a fibroid because it was too large, it reached almost to the costal region, but the only thing this patient reported was discomfort and a little fatigue and yet, as we also presented in the previous video, she had polycythemia, that is, she had more high hemoglobin, a lot of red blood cells, which was a very big point for her. Why? Because if she had any bleeding, it was not going to harm her hemodynamically so much at the time of surgery.
This fibroid was intraligamentary. What does that mean? We have mentioned that the uterus is like our thorax, the tubes are like our arms and they are holding the ovaries as if it were a ball, but in front and behind it is supported by a wide ligament that is like a sheet, which is called the serosa, or we call it the mesosalpinx, then in the middle of the anterior and posterior sheet, below the tube and next to the side of the uterus, that is, near the uterine vessels, was the fibroid. To give you an idea, you are going to see it. This patient did bleed more or less 1 liter 100 ml. Because? Because it was full of blood vessels, but the tumor only weighed four kilos, so it is very important to have prior knowledge. She had a CT scan, then we will also show some images.
Tomography scans are basic, essential, fundamental to differentiate where the uterus is and where the fibroid is, mainly the anatomy, but this patient because the main risk was bleeding rather than removing the uterus because the fibroid was not in the uterus. intraligamentary, these types of fibroids are very rare, they are fortunately infrequent but when they occur, the diagnosis is not so early. It is true that this type of tumors are very vascular because they are in an area where they are… Right now we had a talk , all the blood vessels, both the uterovarian artery, the ovarian artery, the uterine tubal artery, the uterine artery, and the vesical or vaginal arteries.
So, this fibroid was full of blood vessels, in fact when we gave it vasopressin we practically did not do much, I also forgot to mention, this patient had a defect in the left branch of the heart of one of the arteries, she had a heart defect at the same time. do the preoperative assessment and then we could not inject the vasopressin at the standard doses that we normally do, we had to make it a little lower so that it would not have those important vasoconstrictive effects and not harm his heart rate.