AB044. SOH22ABS049. Recurrent vasovagal episodes: a rare presentation of a large prolapsed leiomyoma

Background: Leiomyomas are the most common pelvic tumour affecting women. Prolapsed leiomyomas are described as an uncommon entity in the literature, however specific considerations and priority must be placed on these patients for prompt surgical management due to higher risk of necrosis, increased potential for sepsis and risk of uterine inversion.

Methods: We present an unusual case of vasovagal symptoms secondary to a leiomyoma which has prolapsed through the external cervical os. A 45-year-old woman was referred urgently to gynaecology with menorrhagia, dysmenorrhea and pre-syncopal episodes associated with straining, micturition, defecation and strenuous activity. Bloods and cardiology investigations were normal. Speculum examination revealed a protruding mass through the external cervical os. Abdominal ultrasound described a large homogenous pedunculated mass extending from the fundus of the uterus through the cervix. Hysteroscopy revealed a benign appearing endometrial cavity and a broad 4 cm base of the pedunculated mass. Despite a trial of vaginal removal by torsion manoeuvres, this was deemed not possible due to the wide base of the mass and associated bradycardia and hypotension during hysteroscopy. The surgeon converted to abdominal hysterectomy and bilateral salpingectomy with conservation of the ovaries. Histology of the hysterectomy specimen confirmed a benign leiomyoma.

Results: Vasovagal reactions secondary to leiomyomas protruding through the external cervical os have not been described in the literature. This case outlines the surgical and anaesthetic complexities of such a case.

Conclusions: In conclusion, leiomyomas present with varying complexity and care must be taken to ensure an individualized approach depending on clinical presentation, examination, and pathological findings.

Keywords: Leiomyoma; fibroid; vasovagal; prolapsed; benign gynaecology