By Health In Five Writer
Nimisha Kumar (name changed), a 50-year-old marathon runner from Mumbai with no history of medical comorbidities, noticed pain in her left leg, which with passing days became incapacitating. The patient approached SRV Mamta Hospital, Dombivli for prompt medical attention. On arrival, she had to be received in a wheelchair, as she couldn’t walk due to swelling and pain in the leg. Her left leg veins were completely clogged up with large thrombi (blood clots), a case of Extensive Deep and Superficial Vein Thrombosis. After investigation, she was detected with a large pumpkin-sized pelvic mass i.e. a uterus with a 22 x 25 cm fibroid.
Dr. Jainesh Doctor, Advanced Gynae Endoscopic Surgeon at SRV Mamta Hospital, Dombivli said, “Usually people who stand for prolonged hours or sit in the same position for a long time have a propensity to develop DVT in the legs. She was immediately started on blood thinner medicines to dissolve the blood clots. All her other reports, the intricate DVT lab work came negative. This to our surprise was a rare case of DVT due to extrinsic compression by uterine fibroid.”
Talking about the unusual association of Uterine myoma leading to DVT, Dr. Jainesh said, “This patient had suffered a similar attack of DVT a few months back when she was conservatively managed and had regained routine life. During the investigation, the massive fibroid was localised and concluded as the cause of the DVT. The mass was compressing the left common iliac vein (veins draining the entire lower body) in the pelvic region and was causing hindrance to venous drainage of her leg. Hence, there was no doubt that the mass had to be removed and the compression lifted, at the earliest.
A multidisciplinary team led by Dr. Jainesh decided to perform the complex surgery, “A balanced dose of blood thinners was given and the Inferior Vena Cava Filter was placed to prevent blood clots from breaking off or traveling to the heart or lungs as soon as the mass’s pressure was off the large veins. After 3 days of this, anticoagulation was withdrawn for 6 hours, and the patient was posted for Total Abdominal Hysterectomy with Bilateral Salpingo-oophorectomy [the uterus plus both ovaries and fallopian tubes were removed]. Laparoscopic pelvic surgeries themselves have a minor risk of DVT. So, it was decided to perform an open hysterectomy for this patient. From a 7 cm cosmetic Pfannenstiel (“bikini line incision”), the entire 1.2 kg mass was removed. It was a quick bloodless surgery that lasted around an hour. Lifesaving anticoagulation was started within 4 hours, post this major surgery. The patient was discharged within a week with anticoagulation dose adjustment. She resumed her routine life and went ahead to enjoy her daughter’s wedding 2 months post the surgery. She has resumed her running ritual and the leg thrombus has resolved by 50% size by this time informed the Dr. Jainesh.