Case report – female, 61 years old, Supracervical Amputation of Myomatous Uterus with Advanced Tumor of the Uterus Body
causistic date: 24.06.2008, published: 24.06.2008
Author: Miloš Bláha
A 61-year old female patient was examined for suspected cervical carcinoma. The examination discovered an advanced cervical carcinoma with infiltrations in both parametria with the size of 3 – 4 fingers towards the skeleton and a large myomatous uterus with the total size of 18 × 23 cm, reaching almost up to the processus xyphoideus.
Key words: advanced uterine corpus tumor, supracervical amputation, haemorrhage, haemostasis
A 61-yea-old patient with the histological finding of moderately differentiated adenoacanthoma from separated abrasion was sent from a regional hospital to determine the therapeutic possibilities. Clinical and CT examinations confirmed the infiltration in parametria up to the skeleton and discovered a huge myomatous uterus. After consultation with the department of pathology and anatomy and in view of the clinical finding, an operative diagnosis was established which was advanced cervical cancer. In planning the oncological therapy, surgical removal of the large abdominal finding was recommended despite the infiltration of parametria and technical unfeasibility of a complete surgical solution.
The abdominal cavity was approached via lower middle laparotomy. A large myomatous uterus was discovered which was freely movable within the abdomen and with a rigid, bumpy tumor infiltrating the cervix, parametria, and penetrating into the area of cavum Douglasi. In the light of such finding, decision was made to carry out supracervical amputation with subsequent radiation, in cooperation with oncologists and radiotherapists. The surgeons proceeded to carry out ligation of round ligaments, cutting of vesicoureteral plica. The bladder was pushed down deeply into caudal area with subsequent skeletization of uterine margins up to the vaginal attachment. At this point, the myomatous uterus was amputated in the area of brittle, disintegrating bleeding necrotic tumor. The bleeding was very difficult to stop. All available techniques had to be applied including ligation, electrocoagulation, thermocoagulation, pressure haemostasis, chemical substances and ** the application of several layers of Traumastem TAF/TAF light sewed onto the cervical stump.**The haemorrhage was visually checked over several tens of minutes. The Tramuastem layers were blood-saturated but there were no further signs of primary bleeding. The abdominal cavity was closed layer by layer and a Redon drain was placed in the wound with the size of 5×3 cm. In the post-operative stages, only a minimum quantity of blood and serous fluids flowed out via the drain. Definitive histology confirmed advanced cancer of the uterus with infiltration into the cervix and parametria.
Despite the application of electrocoagulation, pressure haemostasis, thermocoagulation and chemical substances,** the bleeding in the specified area after supracervical amputation of the uterus for advanced endometrial carcinoma was successfully stopped only after application of several layers of Traumastem TAF/TAF light,** firmly sewed onto the remaining infiltrated cervix and parametria. In this way, blood loss was minimized and the need for blood transfusions eliminated. The wound healed without complications. The patient subsequently underwent adjuvant combined radiotherapy and was dispensed in Masaryk Memorial Cancer Institute.
Traumastem TAF/TAF light in this localization proves to be an excellent tool for stopping large area capillary bleeding in necrotic tumors, where other conventional haemocoagulation techniques resulted in being significantly less successful.
