Fibroid expulsion

Patients should be warned pain is the most common reason for re-admission [105]. On discharge, analgesia is switched to oral medications, consisting of non-steroidal anti-inflammatories (NSAlDs) and narcotics. The NSAIDs should be taken around the clock for approximately 10 days with narcotics used as needed. The peak of the pain usually occurs during the first 8-12 h although once they are discharged from the hospital, their pain may be more troublesome for the first day home and will gradually resolve within the next week. If, after improvement of the initial post-procedure pain, the patient develops recurrence of pain, she should immediately report back to the interventionalist since this can represent infection or possibly fibroid expulsion. 

The passage of leiomyoma tissue commonly occurs with those fibroids in contact with the endometrial surface. This phenomenon has been seen up to 12 months after the UAE procedure. This symptom is associated with significant pain, bleeding and most importantly, infection [86]. In cases of suspected fibroid expulsion, MRI should be performed as many fibroids do not pass through the cervix spontaneously or remain attached to the uterine wall and therefore require dilatation and curettage. 

Abbara S, Spies JB et al (1999) Transcervical expulsion of a fibroid as a result of uterine artery embolization for leiomyomata. J Vase Interv Radiol 10 409-411... 

Berkowitz RP, Hutchins FL Jr et al (1999) Vaginal expulsion of submucosal fibroids after uterine artery embolization. A report of three cases. J Reprod Med 44 373-376... 

Kroencke TJ, Gauruder-Burmester A, Enzweiler CN, Taupitz M, Hamm B (2003) Disintegration and stepwise expulsion of a large uterine leiomyoma with restoration of the uterine architecture after successfiil uterine fibroid embolization case report. Hum Reprod 18 863-865... 

Park HR, Kim MD, Kim NK, Kim HJ, Yoon SW, Park WK, Lee MH (2005) Uterine restoration after repeated sloughing of fibroids or vaginal expulsion following uterine artery embolization. Eur Radiol 15 1850-1854... 

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