Dear prof. Koninckx,
I have a uterine fibroid and one part has passed through cervix into vagina, but the larger part is still in the uterus.
I have no pain, no temperature, I can walk and behave as usual.
Ultrasound showed that a fibroid is 11 cm big.   MRI  showed 19 cm.
For the last two months I have a huge yellow, brown vaginal disharge, and doctors said it is necrotizing.
I really wish to do a laparoscopic surgery, since I’m 40 and I haven’t give birth, so I just want to preserve the uterus.
In attachment I sent  an Ultrasound pictures, and I can send you MRI image, too.


Dear Mrs
The diagnosis is not clear to me

A fibroid passing the cervix will give the discharge you have
- such a fibroid is rarely bigger than 5-6 cm and generally a pedunculated intracavitary fibroid which can be removed vaginally
- if the fibroid is avascular and necrotisising the risk of an infection of this mass becomes real. This is not without risk and will need urgent surgery, probably hysterectomy

My guess is that the large 11 or 19 cm fibroid is 1 or more other fibroids.Our approach would be

- let us confirm the diagnosis by clinical exam/ultrasound and proceed to surgery
- I hope we first can remove the intracavitary fibroid  vaginally/by hysteroscopy
- then a laparoscopy should be performed and decisions taken : what I anticipate is
first clip the uterine arteries to prevent too much blood loss
if a 10 cm fibroid : can probably be taken care off by laparosopy
if a 19 cm fibroid it probably is preferable to do a mini-laparotomy


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