Necrosis of uterine fibroids. Necrosis of myomatous node, is it dangerous? Hysterectomy is the main treatment method

It is a complication detected during a disease such as uterine fibroids. Myomatous node is a benign tumor of the muscular layer of the uterus. Its necrosis is associated with impaired blood vessel formation 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 experience a similar phenomenon.

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);
submucosal (protrudes beyond the organ cavity);
intramural (localized in the middle muscle layer).

In the affected tissues signs are found:

swelling;
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

Types of necrosis of the myomatous node are distinguished by morphological characteristics.

Coagulation (dry) necrosis of the myomatous node. The dead zones of the neoplasm shrink and form cavernous cavities, where fragments of necrotic tissue accumulate.
Wet necrosis of myomatous node. Dead tissue softens and forms cystic cavities.
Hemorrhagic infarction (red necrosis of the myomatous node). The tissues of the node acquire soft consistency and red-brown color. Accompanied by dilation of tumor veins and thrombosis. This type of disease is more common in pregnant or postpartum women.
Aseptic necrosis of myomatous node. Necrosis of areas of the myomatous node is accompanied by infectious inflammation hematogenous or lymphogenous 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.

Reasons for the development of necrosis of the myomatous node

Myoma increasing in size can provoke deformation of the vessels that feed it, or compress them. This happens most often for the following reasons:

torsion of the leg of the myomatous node;
bending of the tumor stalk;
node ischemia;
formation of blood clots in the myomatous node.

It is worth noting that twisting of the stalk is more typical for subserous fibroids, which for the most part have thin stalks. Intramural tumors that are under the strong influence of contractions of the muscular layer of the uterus are more often subject 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 impaired blood flow in it.

Symptoms of myomatous node necrosis

A disease such as necrosis of a myomatous node exhibits the same symptoms, regardless of the type. They differ, rather, in the intensity of manifestation depending on the nature of their occurrence:

in case of blood supply disturbance - gradually;
when twisting the leg - sharply.

In general, the symptoms of myomatous node necrosis are as follows:

nagging or cramping pain 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 painful attacks, the development of low-grade fever is not excluded - a condition characterized by a constantly elevated body temperature about a degree above normal.

Diagnosis of necrosis of myomatous node

The first stage of diagnosis for suspected necrosis of a myomatous node involves taking an anamnesis and physical examination of the patient. The doctor pays attention to the following:

abdominal condition: the woman complains of bloating, positive peritoneal symptoms are observed in the lower parts, as well as pain.
state skin: They are distinguished by their pale color.
condition of the tongue: covered with a whitish coating;
state of cardio-vascular system: arterial pressure normal, but the patient complains of tachycardia.

A blood test contains the following signs indicating necrosis of the myomatous node:

increase in ESR;
increase in leukocytes;
shift left leukocyte formula.

Ultrasound of the pelvic organs is aimed at identifying the following parameters:

increase in the size of the uterus;
the appearance of cystic cavities in the node;
decreased 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 determined 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 that cannot be detected by other methods, for example, hemorrhage or swelling in the node. Besides, diagnostic laparoscopy prepares access for later surgical intervention.

Treatment of necrosis of myomatous node

There is only one method of treating myomatous node necrosis - surgery. As soon as the symptoms of this disorder have been identified, the woman should immediately go to the hospital. Necrosis of a myomatous node cannot be cured on an outpatient basis. The choice of operation option will depend on:

patient's age;
the presence of her successfully completed childbirth;
number of myomatous nodes;
the size of each myomatous node;
node locations;
threat of peritonitis.

If a woman is young, of reproductive age, has not yet given birth, or is currently pregnant, she may be prescribed a conservative myomectomy. This operation involves removing 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 of preserving the organ. She can be removed:

body of the uterus with preservation of the cervix;
body and cervix;
body and cervix, appendages and ovaries.

Depending on the complexity of the situation, the operation can be performed using 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 alleviate the degree of intoxication.

Prognosis for necrosis of myomatous node

Modern medicine gives a fairly favorable prognosis if necrosis of the myomatous node was promptly identified and eliminated. In addition, doctors try to preserve reproductive function. However, after the operation, the patient must carefully monitor her condition.

The prognosis worsens if the pathology progresses. This could be peritonitis or blood poisoning, which without proper medical care can lead to disastrous consequences, including death.

Prevention of necrosis of myomatous node

The development of necrosis of the myomatous node can be prevented, first of all, by preventing the appearance of uterine fibroids. Once fibroids have already appeared, treatment cannot be delayed. To avoid complications, it is recommended to undergo preventive medical examination. It includes a gynecological examination and ultrasound of the pelvic organs.

Uterine fibroids are a benign tumor, but this does not mean that they are not dangerous. This disease often has complications that threaten a woman’s life. Special attention deserves necrosis of the myomatous node - a condition requiring emergency care.

What happens to the tumor when necrosis develops, and why is this condition dangerous? We'll figure out.

The essence of the processes that occur when there is a malnutrition of the myomatous node

Every woman who has been diagnosed with uterine fibroids knows that this tumor grows from the muscular wall of the organ - the myometrium. The muscle tissue is very well supplied with blood, which means that the tumor nodes are also fully nourished with blood. When blood flow in the uterus slows down or stops completely, fibroids begin to suffer. Due to malnutrition, irreversible changes begin in it, which inevitably leads to necrosis - the death of tumor tissue.

Everyone can be susceptible to necrosis:

Located outside the uterus and called subserous (sometimes they have a stalk);
Growing into the uterine cavity (submucosal);
Localized in the thickness of the muscular wall of the uterus - interstitial.

Types of myomatous nodes.

Causes of necrotic changes:

Impaired blood supply due to compression of the vessels supplying the node;
Torsion of the base as a result of high mobility of the formation;
Torsion of the pedicle of the subserous node. It can occur during sudden and fast movements (falling, somersaulting, or simply turning awkwardly);
Ischemia – the “Achilles heel” of fibroids – develops due to a decrease in blood flow to the formation for the above reasons;
Thrombosis of the vessels feeding the neoplasm capsule, which leads to disruption of its trophism;
Venous stagnation.

It is important to know

According to statistics, uterine fibroids most often become necrotic during pregnancy, after childbirth or abortion. Therefore, pregnant women with this disease belong to the group high risk on the development of complications and should be under the close attention of obstetricians. written in one of our articles.

Ischemia and necrosis of fibroids are not always bad. Today, one of the widespread methods of treating uterine fibroids is embolization. uterine arteries(EMA), in which tumor ischemia is artificially induced using emboli introduced into the bloodstream. Moving with the blood flow, emboli clog the thin and tortuous vessels of the uterus, the blood supply to this area the organ stops, ischemia occurs, and then tissue necrosis. Our article discusses the technology of the procedure in more detail.

The essence of the EMA procedure.

If ischemia and tissue necrosis were not caused by surgical intervention for the purpose of treatment, but arose spontaneously in the nodes, you should not rejoice at the death of the tumor. This should be considered a life-threatening complication.

What happens in the affected tumor?

When the blood flow in the fibroid node decreases, changes occur in it associated with malnutrition of the tumor: insufficient oxygen supply, slowdown in the outflow of venous blood. With prolonged disruption of the microcirculation of neoplasm tissue, aseptic necrosis develops - tissue necrosis without signs of infection.

After some time, an infection enters the site of aseptic necrosis from nearby organs (the intestines or, more often, the appendix) through the blood or lymph flow. Why is this dangerous?

The causative agents of infection belong to the septic group of microbes (staphylococcus, streptococcus, E. coli). Pathogenic microorganisms contribute to the melting of tumor tissue with the formation of cavities filled with liquid contents. Infection of myomatous nodes deprived of blood flow poses a great danger due to the risk of developing diffuse peritonitis and sepsis.

It's important to understand

In order for necrosis to occur in a tumor node, the blood flow in it and the trophism of its tissues must first be disrupted, and only after that irreversible necrotic changes in the nodule develop.

Types of pathology

Necrosis of uterine fibroids can be dry, wet and red.

Dry necrosis is the gradual shrinking of dead tissue with the deposition of calcium salts in them. This is how calcified fibroids arise, which are characterized by woody density. Calcified nodes are clearly visible on X-ray examination. They are usually painless. Such patients do not require surgical treatment.

Wet necrosis is characterized by first softening and then necrosis of tissues, followed by the formation of cavities filled with liquid contents.

Red necrosis is characteristic of pregnancy. The tissue of the necrotically altered formation has a bright red or dark cherry color.

The photo shows uterine fibroids with torsion of the pedicle and necrosis of the node.

Clinical manifestations of the disease

A woman’s body cannot be ignored pathological changes, occurring in the tumor, which manifests itself in a pronounced clinical picture.

Symptoms of fibroid necrosis:

Pain and tension in the muscles of the anterior abdominal wall. If pathological changes affect a node located on the anterior wall of the uterus, then the pain will be local or spread to the lower abdomen. With a node located on back wall uterus, pain of unknown nature appears in the lumbar region;
Increased body temperature;
Deterioration general condition women (dry mouth, rapid heartbeat, nausea, vomiting, fainting);
Changes in blood parameters - leukocytosis and changes in the leukocyte formula;
A vaginal examination reveals a noticeable enlargement and sharp pain in one of the fibroid nodes.

If the tumor is malnourished, symptoms appear gradually. A woman complains of nagging pain in the lower abdomen and lower back, which increases or decreases over time. During a painful attack there may be nausea, vomiting, chills, and increased heart rate.

Torsion of the tumor stalk is characterized by a clinical picture acute abdomen. The disease develops suddenly with a sharp cramping or dagger-like pain over the womb. Nausea, vomiting, dry mouth, chills, sweating, and intestinal dysfunction in the form of diarrhea are also noted. In case of severe pain, the patient may take a forced position - bend her legs towards her stomach, thereby making it easier for herself painful sensations. can be found in one of our articles.

Pain in the lower abdomen with fibroids can be associated with its intensive growth (compression of neighboring organs) or malnutrition of the nodes.

Sometimes the disruption of the blood supply to the node begins gradually and continues for a long time. In this case, specific complaints and clinical manifestations of tumor necrosis may be absent.

Diagnosis of the disease

Necrosis of the myomatous node can occur under the guise of many diseases, which are characterized by symptoms of an acute abdomen. Therefore, correct diagnosis of the pathology is possible only on the basis of typical complaints, asking the patient about existing and past gynecological diseases (a woman will definitely say that she has uterine fibroids), an objective examination, laboratory and instrumental methods examinations.

What will the doctor find during the examination?

Paleness of the skin;
Dry tongue with a whitish coating;
Tense, sharply painful and swollen abdomen;
A gynecological examination on a chair reveals a noticeably enlarged uterus with myomatous nodes; In the place where tumor necrosis occurs, sharp pain will be noted.

To confirm the diagnosis, an ultrasound scan of the uterus is performed.

What can be seen on a pelvic ultrasound?

Ultrasound with Dopplerography of the node will reveal signs of malnutrition in the fibroid (heterogeneity of the tumor structure with impaired blood flow inside it and in the surrounding myometrium). IN abdominal cavity free liquid is detected.

Ultrasound with Doppler ultrasound of fibroids. Normally, blood flow is determined from the periphery to the center. With necrosis, there is no central blood flow.

Diagnostic laparoscopy

This procedure, using optical instruments, allows you to visually examine the pelvic organs, detect torsion of the legs or signs of neoplasm necrosis.

Nodes that have undergone necrosis appearance significantly different from ordinary nodes. Signs of fibroid necrosis:

The nodes have a dark bluish-purple color;
The formations are soft and edematous in consistency;
White areas of hemorrhage are identified;
Fibroid tissue is fragile and tears easily.

Myoma necrosis and pregnancy

Myoma itself increases the incidence of the following obstetric complications:

Threat of miscarriage;
Fetoplacental insufficiency;
Fetal growth retardation syndrome;
Placental abruption;
Malposition.

Whenever degenerative changes In tumors, pregnant women complain of increased uterine tone and pain in the projection of the location of the node. Their general health also worsens; blood tests reveal signs of inflammation (leukocytosis, increased ESR). The diagnosis is confirmed using ultrasound. If a malnutrition of the tumor is suspected, the pregnant woman is hospitalized in a hospital.

If the trophism of the node partially deteriorates, conservative treatment with antibiotics, antispasmodics, painkillers is first carried out, bed rest and maintenance therapy are prescribed. If the treatment results are positive and the pregnant woman’s condition is stable, conservative treatment is continued.

It is important to know

When the effect of the conservative treatment absent for 2-3 days (prolonged fever, leukocytosis are noted, sharp pains in the abdomen and uterine bleeding), it is always carried out surgery necrosis for health reasons.

During pregnancy radical surgery carried out only as a last resort for health reasons.

If a woman with necrosis of the myomatous node during premature pregnancy (from 14 to 36 weeks) does not have signs of peritonitis, then she will be attempted to undergo organ-preserving surgery, limiting herself only to the removal of the altered formation.

If such a complication develops during a full-term pregnancy (36 weeks or more), C-section and decide to remove the uterus if there is no way to save it.

In case of necrosis of an atypically located node (for example, with cervical-isthmus myoma), as well as in case of ineffectiveness of the initiated conservative therapy, gynecologists have to use extreme measures and remove the uterus along with the fertilized egg, which is a huge tragedy for childless women. , you can find out from another article.

How is the pathology treated?

It is very difficult for a specialist to give advice in each specific case, but all doctors agree that such a patient needs to be hospitalized in a hospital and operated on urgently.

The operation is performed either by laparoscopic or laparotomic access, which is decided individually in each case. The scope of the operation is supravaginal amputation of the uterus or extirpation of the organ with fallopian tubes.

Removal of necrotic nodes alone () is carried out as an exception for young women who do not have children, under the guise of intensive antibacterial therapy.

Hysteroscopic removal of myomatous nodes.

If a malnutrition in the node is suspected, emergency care can be started with conservative therapy (eliminate pain, intoxication, improve microcirculation, prescribe anti-inflammatory drugs). The effectiveness of treatment is assessed after 24-48 hours. If the condition worsens and symptoms of peritonitis develop, emergency surgery is indicated. Conservative therapy is used extremely rarely and only in situations where the risks of surgery are higher than the likely complications of tumor necrosis (for example, during pregnancy up to 22 weeks).

If torsion of the fibroid stalk is confirmed, surgical treatment is provided immediately.

Prevention of necrosis of uterine fibroids

Is it possible to avoid tumor necrosis? You can if you follow these steps:

Timely detection of pathology through annual preventive examinations;
Mandatory annual pelvic ultrasound in the presence of uterine fibroids;
Timely hormonal treatment and surgical removal of nodes that may pose a risk of complications.

If you have uterine fibroids, do not ignore any symptoms of abdominal discomfort. Timely rendered urgent Care will help you avoid radical measures and save the uterus.

An interesting video about how fibroids can be dangerous

About fibroids and laparoscopic removal

One of the complications of oncological tumors is necrotization of their tissues with the development of intoxication syndrome and the formation of a limited inflammatory focus with purulent masses. Necrosis of fibroids is registered in 7% of cases among gynecological pathologies. In addition, during planned removal of tumor formation, in 60% it is detected initial stage necrosis.

What it is?

Myoma necrosis is the death of cells due to inadequate blood supply to the tumor. This leads to irreversible processes that provoke the appearance clinical symptoms and deterioration of the condition.

Necrotization is observed due to insufficient intake nutrients and oxygen to the neoplasm. The tumor can be located subserous, intramural or submucosal.

Timely diagnosis prevents complications and further progression of the disease. For this purpose, medical examinations with gynecological examination are carried out annually, ultrasound diagnostics small pelvis. If uterine cancer is detected, Doppler sonography is recommended to assess the condition of the feeding vessels.

Causes

The cause of insufficient blood supply to tumor formation can be compression or complete closure of the supplying blood vessels as a result of increased tumor formation.

In addition, local circulation is impaired by venous congestion, which slows blood flow, or thrombotic masses, which obstruct blood flow.

Necrotization can be provoked by heavy physical activity, sharp bends, turns, jumps, heavy lifting, etc.

Symptoms

When is it diagnosed? uterine fibroids, necrosis its cells may become a negative consequence of the process. If the death of spruce develops due to twisting of the stalk of the formation, symptoms appear quite quickly.

The patient is worried about severe cramping pain in the abdomen spreading to the lumbar, groin, perineum, fever, nausea and possible vomiting. Intestinal dysfunction may include bloating, constipation, and failure to pass gas.

Manifestation

Clinical manifestations when the lumen of the feeding blood vessels is partially blocked, they appear gradually as the volume of dying structures increases.

The patient is bothered by aching, pulling pain. They are localized in the lower abdomen, spreading to the lower back and perineal area. Also, a persistent increase in temperature to 37.5 degrees is possible.

In addition, dyspeptic disorders appear in the form of nausea, vomiting and bloating.

Aseptic necrosis of fibroids

Necrosis of the neoplasm, that is, its necrotization, can occur without the participation of infectious agents, which indicates an aseptic process. In addition, in this case, toxic substances do not spread through the bloodstream, as a result of which sepsis does not develop.

Necrosis of fibroids during pregnancy

When planning a pregnancy, it is mandatory to full examination women to avoid the progression of any diseases and the occurrence of complications during the process of bearing a baby.

Necrotization of tumor formation during pregnancy is observed as a result of increased vascular tone, slowdown and deterioration of local blood circulation, in particular in the myometrium, and impaired venous outflow.

It is also worth noting that the pathological formation increases with the growth of the uterus and can compress blood vessels. The longer the pregnancy, the more risk death of the tumor focus.

Concerning postpartum period, observation of the patient is also necessary, because the uterus begins to contract and medicines stimulating its reduction. As a result, the risk of compression of the supply vessels increases.

Health implications

Necrotization of the neoplasm, depending on the degree of disruption of the blood supply to the pathological focus and the area of its death, can lead to peritonitis and a septic condition. Toxic substances released when cancer tissues die are absorbed into the bloodstream and distributed throughout the body.

To prevent serious consequences, it is necessary to undergo regular medical examinations, especially before planning a pregnancy.

How dangerous is it to life?

Necrotization of the pathological focus can cause bleeding, which leads to anemia and decreased blood pressure.

In addition, inflammation is possible, manifested in the form of peritonitis. At first it is limited, and then spreads throughout the pelvis, which leads to the formation of diffuse peritonitis. At the same time, the patient’s condition worsens, sepsis develops, the temperature increases to 39 degrees, pain occurs, and there is a tendency for pressure to decrease.

Treatment

It is possible to prevent complications by timely removal of tumor formation. In some cases, hysterectomy (removal of an organ) is performed. In case of peritonitis, immediate surgical intervention is required with removal of the tumor, sanitation and drainage of the cavity.

In addition, infusion therapy should be performed to detoxify, restore electrolyte balance and stabilize blood pressure.

Forecast

The prognosis is favorable provided that it is detected and treated in a timely manner. In the case of peritonitis and septic conditions, the prognosis depends on the duration of inflammation, the degree of its spread, the severity of the infection, the presence of concomitant pathology and the general condition of the patient.

Necrosis of fibroids with serious complications can be prevented. It is enough just to undergo regular examinations with a doctor and be attentive to your health.

Uterine fibroids are a benign tumor, but this does not mean at all that the disease does not pose any danger to the health and life of a woman: if treatment is untimely or negligent about one’s well-being, various complications can arise, including necrosis of the fibroid node. This condition is considered very critical and requires emergency care.

What exactly should be understood by the necrotic process of a tumor, what symptoms indicate the development of such a phenomenon, and how doctors can help in this situation - all these are questions of interest to patients diagnosed with uterine fibroids.

Uterine fibroids are a fairly common gynecological disease. Many women, upon hearing such a diagnosis, fall into a state of panic, believing that we are talking about malignant tumor. In fact, this is not so: fibroids are benign neoplasm, which grows from the muscular layer of the organ. Nodes of small size, with timely diagnosis and the absence of severe symptoms, can be treated with medication (we are talking about hormone therapy), but with large tumors, in which the uterus increases to a size corresponding to 12-15 weeks of pregnancy, specialists fight only through surgical removal. In advanced cases, a radical operation may be performed, consisting of partial or complete removal of the patient's uterus.

Late diagnosis of leiomyoma is dangerous not only due to the loss of the reproductive organ, but also a number of complications that can arise against the background of this unpleasant pathology. Among them - heavy bleeding and anemia arising due to them, torsion of the legs of the myomatous node, purulent processes in the fibroid and surrounding tissues, miscarriage, development ectopic pregnancy, difficult childbirth, tumor malignancy. The latter phenomenon is considered rare: the degeneration of uterine fibroids into a malignant formation occurs in only 1.5-3% of patients.

Another complication of the disease is the death of tumor tissue. IN medical practice necrosis of the myomatous node occurs in 7% of all cases possible complications leiomyomas, while in 60% of given number During surgery, impaired blood circulation is observed. Thus, necrotization of fibroids is the death of its tissues, which is the result of insufficient blood supply to the tumor.

At the same time, any circumstance leading to a deterioration in blood circulation can provoke destruction of the myomatous node: twisting of the vascular pedicle, the presence of blood clots, venous stagnation, compression and deformation of blood vessels occurring due to excessive growth of the fibroid itself. Leomyoma becomes a frequent occurrence during pregnancy, when the intensity of blood flow in the uterus and the speed of blood flow decreases, vascular tone increases, and venous congestion forms.

Necrosis of fibroid tissue often occurs after childbirth or abortion, during which oxytocin is often administered, causing rapid contraction of the myometrium. Under such circumstances, muscle tissue begins to compress the node, impairing its nutrition and causing cell death.

In addition, the risk of necrotization process increases significantly when performing physical activity: lifting heavy objects, sharp turns, jumping.

With the deterioration of blood flow in the fibroid, changes begin regarding the malnutrition of the pathological node: lack of oxygen, delay in the outflow of venous blood. When such processes occur over a long period of time, avascular necrosis occurs - tissue death without corresponding signs of infection. With the flow of lymph or blood, an infection penetrates into the necrotic lesion from neighboring organs - Escherichia coli, streptococcus, staphylococcus, which melt the neoplasm tissue and transform them into cavities filled with pathological contents. As a result, the risk of developing sepsis or peritonitis increases significantly, so this condition requires immediate surgical intervention.

Video: Relationship between myomatous nodes and cancer

Clinical picture

The symptoms observed with necrosis of uterine fibroids can be different, depending on the factor that caused this complication. Clinical manifestations that arise against the background of any of the above reasons, except for the bending of the leg, as a rule, arise gradually and are of an increasing nature.

However, the situation is completely different with twisting of the tumor’s leg: the patient exhibits signs of an “acute abdomen”, which often manifest themselves suddenly and quite strongly. This condition is characterized by an increase in body temperature up to 39 C, severe pain that resembles acute, cramping pain, nausea and vomiting. Often, in addition to this, there is a frequent urge to urinate and pain during it, there is a delay in the passage of gases, and the feeling of incomplete emptying of the bladder begins to bother you.

During a vaginal examination, sharp pain and enlargement of the uterus are noted in the area where the myomatous node is located. Pathological neoplasms located on the anterior wall of the organ are accompanied by local pain, as well as unpleasant sensations affecting the lower abdomen. Pain with fibroids, diagnosed on the back wall of the uterus, is of a different nature - they remind of themselves in lumbar region, and therefore are often defined as pain of unknown origin.

Along with this, the patient’s general well-being worsens: weakness, dry mouth and arrhythmia appear, sweating increases, chills bother him, and fainting occurs.

When the myomatous node is necrotized, information also becomes laboratory research: leukocytosis is detected in the woman’s blood, changes in the leukocyte formula are noted. A significant number of leukocytes are also detected with a smear from the cervical canal. All this indicates that an irreversible pathological process is occurring in the body.

Types of myomatous node necrosis

Based on the morphological characteristics, several types of necrotization of uterine fibroids are distinguished.

Dry (coagulative) necrosis, the essence of which is the gradual wrinkling of dead areas of tissue, accompanied by deposits of calcium salts in them. This results in the formation of a calcified tumor, which is characterized by excessive density. As a rule, such neoplasms are painless and can be easily monitored using X-ray examination.
Wet– with this type, cysts are formed filled with pathological contents. They are formed as a result of the gradual decomposition of dead areas. It flows quite slowly, so the liquid penetrates into the tissues.
Red (hemorrhagic)– most often occurs with an intramural tumor, which is located inside the wall of the organ. Such necrosis can be caused by dilatation of the veins extending from the pathological focus. Most often, this complication of uterine fibroids occurs in pregnant women. A myomatous node with red necrosis has a loose consistency, a reddish-brownish color and dilated veins, which are characterized by thrombosis.

A special place is given to another type of necrosis - aseptic. It does not fit into histological differentiation, since it is characterized by its pathogenetic basis. In this case, the process of necrotization of fibroids involves lymphatic and blood vessels, which creates a risk of infection through hematogenous and lymphogenous routes. Pathological microorganisms, penetrating into other parts of the body, become the root cause of peritonitis or sepsis.

Diagnostics

Confirmation of the diagnosis of “necrosis of the myomatous node” is carried out on the basis of anamnestic data, external examination, as well as the results of laboratory and instrumental research methods. In addition to the external assessment, the specialist must examine the patient in a gynecological chair.

There is pallor of the skin, coated tongue, bloating and pain in the lower part of the abdomen during palpation. During the gynecological examination, the doctor notes the increased size of the uterus; in some cases, pathological neoplasms are palpated, while the patient complains of pain in the area where the myomatous nodes are localized.

Important information can be obtained from a blood test: an increase in ESR and leukocytes with a shift in the formula to the left gives reason to assume that the patient is undergoing a necrotic process of tumor tissue.

Ultrasound remains one of the most relevant, harmless and safe for health research methods. This procedure also used to confirm or refute suspicions of necrotization of uterine fibroids. Such diagnostics are carried out using Doppler, thanks to which the specialist evaluates not only the neoplasm itself, but also the characteristics of its blood supply.

Signs indicating the death of a myomatous node include:

deformation of the tumor contour;
the presence of cystic cavities filled with fluid;
tissue heterogeneity;
increase in anterior-posterior parameters of the uterus;
impaired blood circulation in the fibroid itself, as well as in the tissues adjacent to it.

To clarify the diagnosis, in the absence of contraindications, laparoscopy is performed - surgery, during which specialists have the opportunity not only to study the pathological focus in detail, but also to carry out all the necessary therapeutic measures. During laparoscopy, myomatous changes in the uterus with characteristic features necrotization: the surface of the tumor has bluish or dark purple areas, swelling of the tumor is visualized, and hemorrhages are observed.

Video: Uterine artery embolization. Necrosis of the node.

Myoma necrosis and pregnancy

It was previously noted that one of the reasons causing necrotization of fibroids is pregnancy. The uterus, adapting to the development of the unborn child, increases in size, and along with it the myomatous node grows. Since the blood by and large goes mainly to the fetus, the surrounding tissues begin to experience a lack of oxygen and nutrients. As a result, the vessels feeding the tumor gradually regress, which leads to the development of ischemia. A lack of trophism observed over a long period of time leads to the death of cellular structures.

In addition, the enlarging uterus compresses neighboring organs, the veins and arteries of the myomatous node undergo constriction, as a result of which the blood flow in them slows down, and often until it stops completely.

During gestation, the level of hormones responsible for the contractility of the uterus also increases closer to late dates pregnancy. And if necessary, the woman is prescribed drugs that help reduce muscle tissue. This circumstance becomes a compelling reason for the narrowing of the vascular lumen, which in turn negatively affects local metabolism.

With the occurrence of destruction of a benign formation, a woman experiences the following symptoms:

deterioration general well-being;
increased uterine tone;
pain in the lower abdomen;
V laboratory tests leukocytosis and an increase in ESR concentration are observed.

If necrosis of the myomatous node is suspected, the patient is hospitalized and left in the hospital for further monitoring of the ongoing pathological process. If trophism is only partially impaired, conservative therapy is first carried out: specialists use painkillers and antibacterial drugs, antispasmodics, the woman is prescribed bed rest aimed at maintaining pregnancy. In the event that positive dynamics result drug treatment absent: fever continues, acute and sharp pain is still noted, an increased level of leukocytes is observed in the blood, uterine bleeding is present, surgeons, in the absence of contraindications, perform resection of the fibroids.

Failure to provide medical care in a timely manner can result in a number of serious complications:

miscarriage;
placental abruption;
fetoplacental insufficiency;
malposition or fetal growth restriction syndrome.

For full-term pregnancy, which ranges from 36 to 40 weeks, a cesarean section is performed followed by resection of the myomatous node or complete removal uterus, if it is impossible to preserve it.

How is the pathology treated?

Treatment of uterine fibroid necrosis folk remedies excluded, since this pathological process is an irreversible condition. Often even drug therapy, aimed at improving microcirculation and eliminating intoxication of the body, becomes ineffective, and in the absence positive result within 24-48 hours, specialists still decide to perform surgery.

The operation can be performed either using a laparoscope or through laparotomy with an incision in the abdominal wall. The determination of the required method is carried out on an individual basis, depending on the age and parameters of the tumor, the age of the patient, the presence or absence of pregnancy, technical capabilities, risk factors for anesthesia, etc.

Myomectomy, the essence of which is to remove only the tumor, is performed extremely rarely. The main circumstances predetermining the choice of this technique are pregnancy and the need to preserve the patient’s reproductive ability if she does not yet have children. Other cases involve absolute resection of the organ, which in medicine is called a hysterectomy. Together with the affected organ, one or both ovaries and the cervix can be removed - it all depends on the characteristics of each specific situation.

The surgical operation, due to the urgency, is carried out by making an incision in the abdominal cavity. In some cases, specialists perform a vaginal hysterectomy.

After resection of the uterus, most patients experience complications that tend to resolve fairly quickly. These include bleeding, pain, and infection of the genitourinary tract, resulting in the development of cystitis.

Immediately after surgery, the woman is allowed to stand up and walk - these measures are necessary in order to prevent the formation of venous blood clots and pneumonia. After laparoscopy, the patient is given sick leave for 9 days, laparotomy frees you from work for a period of 2 weeks. At home, taking a hot bath, douching, lifting weights, and performing physical labor is not recommended. In addition, experts advise abstaining from sexual relations for 2 months, especially if a total resection was performed.

Necrosis of myomatous node after embolization

Embolization is the newest method of combating uterine fibroids, which has recently been used in Russia. By the way, this operation has been carried out all over the world since the 70s, while initially UAE was performed to stop uterine bleeding directly during the operation, and only then did it become an independent method of surgical treatment benign tumor. In 1996, embolization gained its right to exist in the United States, and, starting in 1998, it began to be used in the Russian Federation.

The essence of endovascular embolization of the uterine arteries is to stop the blood supply to the fibroids, as a result of which the fibroid nodes decrease in size and then, in a favorable situation, disappear altogether. Benefits this method speakers:

effectiveness and the possibility of relapse in only 1% of all cases;
minimally invasive: no need to make an abdominal incision;
safety;
local effect on the tumor, which is carried out practically without affecting healthy tissue;
preservation of the reproductive organ and, accordingly, the ability to bear children;
performing an operation without general anesthesia;
low risk of complications;
fast recovery.

After UAE, myomatous nodes shrink in size within 3 months, and the woman gradually recovers menstrual cycle, she can lead her previous normal sex life.

Preparation for embolization of a myomatous node requires a mandatory ultrasound, which is necessary to exclude contraindications that do not allow such an operation: malignant neoplasms And inflammatory processes in the genitourinary system.

UAE is performed under local anesthesia: a thin catheter is inserted into the femoral artery to the very place where it begins to branch and supply blood to the fibroid - through it, particles of plastic drugs or gelatin sponge are introduced, which, penetrating into narrow vessels, clog them and thereby stop the flow of blood into the cellular structures of the node. This is done in both femoral arteries. After this, specialists proceed to a repeat arteriogram (the first is carried out during the initial introduction of a catheter tube) - the introduction of a contrast agent visible on radiography. Such measures are necessary to completely exclude blood supply to the tumor. A sterile bandage is applied to the puncture sites for 10-12 hours, after removing which the UAE is considered complete.

Thus, this is another reason for the process of necrotization of fibroids, which takes place under medical supervision with the further use of drugs that prevent the development of complications of this procedure.

Video: Uterine fibroids. part 2. Diagnosis and treatment of uterine fibroids. Types of fibroids and classification

Prevention of tumor necrosis

By following certain preventive rules, you can avoid the development of fibroid necrosis. To do this you need:

visit a gynecologist regularly;
undergo transvaginal ultrasound examination annually; for patients with myomatous nodes, such diagnostics are indicated 2 times a year;
apply for timely medical care when a benign uterine tumor is detected;
carry out surgical treatment of fibroids one year before planning pregnancy.

After surgery to remove a myomatous node, it is recommended to refrain from conceiving a child for one year; for this purpose, the patient is prescribed oral contraceptives.

In the event that the ovaries were removed along with the uterus, the need for hormonal therapy is considered. As a rule, this approach not only promotes the rapid restoration of a woman’s sexual function, but also prevents the development of obesity, post-hysterectomy syndrome, osteoporosis, and cardiac dysfunction.

If any alarming symptoms: pain in the lower abdomen, bloody discharge between menstruation, bleeding during menstruation, deterioration in general health, you should immediately contact a specialist for examination and further identification of the source of the disease. This will allow us to determine the pathology early stage development and prevent the adoption of radical measures associated with total resection of the uterus.

Ischemia of the myomatous node- this is a decrease in its blood supply due to the cessation or decrease in the flow of arterial blood.

Necrosis of myomatous node- this is an extreme decrease in blood supply to the myomatous node with complete or partial necrosis of myomatous tissue.

Both necrosis and ischemia of the myomatous node are complications of uterine leiomyoma.

Most often it occurs during pregnancy due to the inability of tumor vessels to provide increased blood supply needs. But it also happens outside of pregnancy, as well as in postmenopausal women, uterine leiomyoma which I had never bothered before.

This is what it looks like necrosis of myomatous node during surgery:

Epidemiology

Frequency ischemia of the myomatous node during pregnancy is 6-16%, necrosis - 0.5-1%. Outside of pregnancy, this complication is less common, since ischemia outside of pregnancy is less pronounced and there are almost no symptoms.

Pathogenesis

A necessary condition for the progression of uterine leiomyoma is an adequate concentration of sex steroids in the serum (estrogens, progesterone). Sex steroids have the ability to stimulate the growth of fibroids both directly and by enhancing the synthesis of growth factors and other biological factors. active substances tissue of leiomyoma and surrounding tissues. Local synthesis of estrogens is important, since it has been proven that leiomyoma contains a large number of the enzyme aromatase, which converts androgens into estrogens, and 17-beta-hydroxysteroid dehydrogenase, which converts weak estrogens (estrone) into more powerful ones (estradiol).

Uterine leiomyoma is a tumor with a reduced blood supply compared to normal myometrium. In addition, fibroid vessels do not have a muscle layer and innervation, which makes the blood supply ineffective. Rapid tumor progression increases the inadequate blood supply and causes ischemia and then necrosis.

Clinical manifestations

Complaints. Pain in the lower abdomen. In case of pronounced pain syndrome- nausea, vomiting, lack of appetite. Sometimes - hyperthermia. Such a patient usually has a history uterine leiomyoma. The complication usually occurs acutely.

With severe pain, the patient may take a forced position. Upon examination, an enlarged, lumpy, sharply painful uterus may be detected. During pregnancy, there is usually a painful area on the uterus.

Complications and consequences if left untreated

With the development of total necrosis of the myomatous node, in very rare cases, peritonitis may occur with all the characteristic symptoms, a significant deterioration in the general condition, intoxication and even death of the patient in advanced cases.
Septic condition
During pregnancy - miscarriage, fetal death.

Diagnostics

Laboratory data. General analysis blood, urine. Coagulogram. If necrosis is suspected, inflammatory markers such as C-reactive protein may be additionally used.
Instrumental research methods. Ultrasonography, Dopplerography of the vessels of the myomatous node. MRI

MRI picture of a myomatous node with signs of ischemia from above against the background normal nodes from below (sagittal projection, T2, 1.5 Tesla):

MRI picture of a myomatous node with areas of necrosis (sagittal o-section, T2, 1.5 Tesla):

Differential diagnosis:

Threat of miscarriage or premature birth(during pregnancy).
Necrosis and torsion of the leg of the myomatous node.
Torsion of ovarian cyst.
Purulent tubo-ovarian formation.
Appendicular infiltrate or abscess.
Tumors of extragenital origin with pain syndrome.

If there are difficulties with the diagnosis, consultations with other specialists, most often a surgeon, may be necessary.

Treatment

Goal of treatment. Relief of pain syndrome. Reduction of ischemic phenomena. For necrosis, in some cases, surgical treatment with removal of the node is the only treatment.

Drug treatment. Non-steroidal anti-inflammatory drugs. Crystalloid solutions intravenously. Antispasmodics, tocolytics (during pregnancy). In persons with hypercoagulability - antiplatelet agents and anticoagulants.
Surgical treatment. At ischemia of the myomatous node not shown. At necrosis of myomatous node may be indicated even during pregnancy. The scope of intervention depends on the patient’s age, her reproductive plans and the specific clinical situation. In the case of young age, incomplete reproductive function and limited necrosis to the myomatous node, organ-preserving interventions are possible. In other cases, the uterus is removed ().

Prevention

Timely treatment uterine leiomyomas before planning a pregnancy. Use of adequate contraception in patients uterine leiomyoma.