Uterine Fibroids
Patient presentation:
J.F., a 46-year old patient presents to her GYN with increasing menorrhagia and dysmenorrhea. Her menses have become progressively heavier in the past year and were now impacting her ability to do her normal activities and go to work. She is found to be anemic, with an H&H of 10.0 g/dL and 30.5%. Upon bimanual exam, her GYN notes an enlarged uterus. Serum hCG is negative. On ultrasound, a large fibroid tumor is noted. The patient is placed on combined oral contraceptives for six months; at the end of this time, there is no reduction in the size of the fibroid and no significant change in the menorrhagia and dysmenorrhea. The patient opts for total hysterectomy.
Treatment:
The patient undergoes laparoscopic hysterectomy with preservation of the ovaries. Her surgical procedure is uneventful and she is transferred to an inpatient room after three hours in PACU. She is given IVF of D5LR at 125/hr on the floor, has a Foley catheter which was placed intraoperatively, and is on O2 2L via nasal cannula. She has three laparoscopic incisions—one at the umbilicus and one each on the right and left lower abdomen. The incisions are sealed with Dermabond and covered with Telfa and Tegaderm. The patient does well through the night and on her first morning postop, her catheter is removed and her diet is advanced to clear liquids, which she tolerates well, progressing to solid food for lunch. At this time, she is switched from IV pain medication to oral. She ambulates in the halls and voids adequately. Her morning H&H is 9.5 g/dL and 29.7%. The surgeon discharges her in the afternoon and she goes home.
Outcome:
At home, the patient progressively increases her activity and requires less pain medication. She returns to work after five weeks. H&H at eight weeks post-op has risen to 13.0 g/dL and 37%. She is (of course) amenorrheic and her quality of life improves.
Case created by Jessica Fehr, 2010.