A Text-book of Diseases of Women

by Charles B. Penrose

Fig. 133.—Subperitoneal fibroids and an intra-ligamentous fibroid of the uterus.

Such a hard, freely movable tumor often causes a great deal of peritoneal irritation. A serous fluid may be thrown out by the peritoneum, and a moderate degree of ascites may occur. Adhesions may be formed between the fibroid tumor and contiguous structures—the abdominal parietes, the omentum, or intestines. These adhesions are often exceedingly extensive, firm, and vascular, so that in some cases the tumor derives its chief blood-supply and mechanical support from such adventitious attachments. The uterine pedicle may, as a result of progressive atrophy, traction, or violence from a fall, become detached, and the tumor, having then lost all uterine connection, appears to be a fibroid growth of the omentum, intestine, or abdominal wall. This is the origin of many so-called fibroid tumors of these structures.

Detachment from the uterus may also occur, as the result of atrophy of the pedicle or of violence, in the case of a pediculated subperitoneal fibroid that has not contracted adhesions to other structures, and the tumor will then be found free in the abdominal cavity.

The subperitoneal fibroid in its upward growth sometimes drags the body of the uterus with it, and in this way may produce great elongation and distortion of the cervix.

The submucous fibroid grows toward the uterine cavity. It presses the mucous membrane before it, and it may enter the cavity of the uterus, being altogether extruded from the uterine wall. It then forms a pediculated tumor lying in the uterus—an intra-uterine polyp. The pedicle is composed of dense fibro-muscular tissue, and is invested by a sheath of mucous membrane, unless this structure has been destroyed. The pedicle may be but slightly vascular, or it may rarely contain large arteries. As a general rule, the greater the degree of the extrusion of the polyp and the longer the pedicle, the less is the vascular supply. Rapid spontaneous hemostasis occurs after a fibroid polyp is cut from its pedicle, as a result of the thickness of the arterial walls and the contractility of the pedicle.

The intra-uterine polyp, from prolonged pressure, sometimes acquires the shape of the uterine cavity.

Uterine contractions are excited by the presence of the polyp, and the tumor may in time be expelled from the uterus, enter the vagina, and protrude at the vulva.

Submucous fibroids form the most usual variety of uterine polypi. In some cases the overlying mucous membrane becomes much stretched and attenuated, and may finally rupture or slough. The fibroid tumor may then escape through the opening in the mucous membrane, and, having been extruded altogether from the uterine wall, may be expelled from the body by uterine contractions.

The fibroid polyp, being exposed to septic influences from the vagina, may become inflamed and suppurate; or sloughing and disintegration may occur because of interference with the blood-supply in the pedicle.