Uterine fibroids are common, non-cancerous growths that develop in the muscle wall of the uterus. They affect up to 80% of women by age 50 and often cause symptoms like heavy bleeding or pelvic pressure, though they are rarely life-threatening. However, the specific type known as a pedunculated fibroid carries unique structural features that introduce a distinct risk profile.
Understanding Pedunculated Fibroids
The distinguishing feature of a pedunculated fibroid is its attachment to the uterus by a thin, stalk-like connection called a peduncle. This stem is composed of the same smooth muscle as the fibroid itself and connects the main mass to the uterine wall. This structure differentiates them from sessile fibroids, which are attached directly without a stem.
The location of the stalk determines the fibroid’s classification as either submucosal or subserosal. A pedunculated subserosal fibroid grows on the outer surface of the uterus, projecting into the pelvic cavity. In contrast, a pedunculated submucosal fibroid grows inward, protruding into the uterine cavity. This free-hanging structure creates the condition for a specific mechanical complication not seen in other fibroid types.
The Specific Acute Risks
The primary acute risk associated with pedunculated fibroids is torsion, or twisting. Because the fibroid is suspended by a stalk, it can rotate on its axis, especially if it is large or if there is sudden movement. This twisting action is serious because the peduncle contains the blood vessels that supply the fibroid with oxygen and nutrients.
When the stalk twists, the blood supply to the fibroid is cut off, a condition known as ischemia. The lack of blood flow starves the tissue, causing the fibroid cells to die in a process called infarction or necrosis. This tissue death causes the sudden, intense symptoms and is considered a surgical emergency. Torsion is a unique danger specific to the pedunculated type.
Identifying Emergency Symptoms
The most telling sign that a complication like torsion has occurred is the sudden onset of severe, sharp pelvic or abdominal pain. This pain is often localized to the area where the fibroid is situated and is typically unrelated to the menstrual cycle. The intensity of this pain results directly from the lack of blood flow and tissue death within the fibroid.
Accompanying the intense pain, a patient may also experience secondary symptoms like nausea and vomiting. A low-grade fever may develop as the body reacts to the degenerating tissue. These acute symptoms signal that the condition requires immediate medical evaluation. Physicians must differentiate this acute event from other causes of sudden abdominal pain, such as a ruptured ovarian cyst or appendicitis.
Clinical Management and Treatment
When a pedunculated fibroid is identified but is not causing any symptoms, a strategy of watchful waiting is often employed. This involves regular monitoring to track any changes in the fibroid’s size or the development of new symptoms. However, if the fibroid is causing chronic issues or if torsion is suspected, intervention is necessary.
In the case of suspected or confirmed torsion, emergency surgical removal is typically performed. The procedure of choice for symptomatic pedunculated fibroids is a myomectomy, which removes only the fibroid while preserving the uterus. This surgical approach is often done using minimally invasive techniques, such as laparoscopy, to remove the mass and its twisted stalk. While non-surgical options like Uterine Artery Embolization (UAE) are used for other types of fibroids, surgery is frequently preferred for pedunculated fibroids to directly address the stalk and remove the dead tissue.