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FIBROIDS in uterus. Should UTERUS, GALLBLADDER be removed?

Resolved Question:

Hello Doctors,

Attached are the reports of my sister in law
The local gynecologist who we consulted have advised surgery for removal of uterus and removal of gall bladder.

Since she is unmarried yet, we want to be sure of the right course of action.
Another gynacologist has recommended that the gallbladder needs to be removed, however uterus does not need to be removed.

Please if you would review the report and provide your recommendation on best course of action.


History:
Sister in law has had uterus fibroid for few years. No active medication was taken.
She also had irritable bowel and ulcerated colitis and has been taking medication for that.

Thanks
Best Regards
Satish Shridhar


Category: OBGYN

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Category: Infertility Specialist
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Hello,
Thanks for posting your query at DoctorSpring.com
I have reviewed the reports.
There are two issues here.
First the gallbladder polyp.
Some polyps in the GB can be followed up with ultrasound scan and some need to be removed surgically.
The scan attached by you mentions no details of the polyp - size, texture etc.
SO I need details of the size and kind of polyp so that I can tell you if it is necessary to remove the GB.
Also, if the polyp is symptomatic ( causing pain, indigestion, discomfort, then it should be removed ).
The second question regarding the fibroids.
Yes there are multiple fibroids in the uterus, and they should be removed only if she is symptomatic ( experiencing lower pelvic pain, heavy bleeding, irregular bleeding etc ).
If there are no symptoms, it can be left alone as fibroids mostly shrink after menopause.
As an alternative, there are medications / injections that can be given to shrink the size of the fibroid.
So I do not think there is any indication straightaway to remove the uterus.
All the best
Please feel free to discuss further.


Patient replied :

Hello Doctor, Thanks for your guidance, attached please find the reports on Polip size and details from the scan. Also attached is a medical history, medication etc from my sister in law. Please could you kindly advise after reviewing the history and additional scan reports attached here. Thanks Best Regards Satish Shridhar
I am unable to attach all the documents, is there an email address I can send the documents to please?

history below:

From age 18 been having diarrhoea, doctor report nervous diarrhoea, seen a Psychiatrist, and prescribed, ALprax and Ativan 1mg.
Age 19 diarrhoea and blood in the stools taken colono scopy and endoscopy, Reports were normal just having Anal Fissure ,and grey white tissue seen still taking Psychiatric medication from then up to now.
Always having diarrhoea for years been diagnosed with IBS and was on bland diet.
1997 had bout of diarrhoea, taken a stomach scan report were stone in the Gallbladder size 1 mm.
Always had bouts of diarrhoeas on and Off I took yearly stomach scans and there were a stone in gallbladder 1mm.
From 2003 at age 29 had bouts of diarrhoea taken a colonoscopy, reports 3 patchy colitis.
2003 stomach scan revealed mucosal polyp of 5x 10 mm.
MESACOL and MEBIZ sr for 6 months. And repeated the same medication on and OFF.
2006 at age 32 taken colonoscopy and my results
Macroscopic description; Bottle marked sigmoid, received four grey white soft tissue bits measuring 0. 2 cm across each – 4 all.
IMPRSSION; Mild Nonspecific chronic colitis, Negative for granulomata or other specific features.
At age 32 at 2006 stomach scan reports showed for Gallbladder is
Is moderately distended
.There is a immobile non shadowing echodence area measuring 0.9 x 0.7 cms identified in the posterior wall of the gallbladder. Impression; solitary cholesterol crystals/ Adherent Calculus.
Uterus; There is a hypo echoic mass measuring 0.9 x 0.8 cms (Intramural) identified in the anterior wall of the uterus.
At age 34 2006 Went to a Psychiatrist treatment and my diarrhoea stopped had not experienced any stomach pains discomfort. And started eat normal food and now for the past 5 years been able to eat meats etc. Now im no longer on a diet. My medications were.
Daxide 100 mg at night,
Ativan 1mg at night
Daxide 50mg in the morning.
At age 35 2010 stomach scan reports but my gall bladder never really bothered me I didn’t have any symptoms.
Gall Bladder; Is adequately distended. Multiple calculi are noted in the gall bladder the largest measuring 7.6 mm. Wall thickness is normal.
Uterus; Measure 5.9 x 5.3 x 4.2 cms. Anteverted
A well-defined hypo echoic lesion measuring 2.6 cm is noted in the fundus.
Endometrial is regular. Endometrial thickness 7.3 mm cervix measures 3.7 cms.
Impression;
CHOLELITHIASIS> FUNDAL FIBROID
LEFT OVARIAN CYST
I still have no symptoms of indigestion or any stomach discomfort. Doctor advised to take a stomach scan regularly to check the gall bladder.
At age 37 2012 I had taken a stomach scan, The IMRRESSION; is 2 Gall Bladder polyps and 2 Uterine Fibroid. I’m so sorry I can’t seem to the f find the rest of the result, but I do know the Polyps and the fibroids have grown. I was starting to have irregular periods, and sometimes I had periods twice a month and then it stopped. From 2009 at age 35 I didn’t have my period for 4 months and then I was getting my periods twice a month for about 2 months.
At age 39 2014 I was diagnosed with Bronchitis Asthma and been treated with all kinds of antibiotic and unable to keep it under control. I keep getting attacks every other month my reports and medication report are in the hospital files and am unable to give you my reports.
From 2014 at the age of 40 in developed high blood pressure am taking Envis 2mg in the morning its not under control so the doctor keeps raising my dosage at present am taking Envis 10mg in the morning. And my pressure is lightly high 150/ 90.
Now at present 2015 am at 41 yrs,I keep getting periods every other week for 2 months February, and March and after that’s for pass 1 and half month I haven’t got my periods.
At present the medication I’m on,
Daxide 100mg at night
Daxide 50mg in the morning
Ativan 1mg at night
Nitrest 10mg at night
Prothiden 75mg at night and
Envis 10mg in the morning.
For my asthma I’m taking
BRONCHORIL 100mg in the morning and at night.
Qnext 1 in the afternoon
Montex 10mg 1 at night
Levolin inhaler. Only if I cough.
Seroflo inhaler 125 at night.
My latest blood report and my stomach scan results I’m sending you as an attachment file.










.


Hello,
Regarding the gallbladder, polyps less than 1 cm do not warrant removal, particularly if you are asymptomatic.
The only concern with GB polyps is their likelihood of turning malignant, and the risk of malignancy in polyps increases if the polyp size is more than 1 cm, and a single polyp is more likely to turn malignant, as compared to multiple polyps.
So, if you develop symptoms , or further scanning indicates an increase in size of the polyps, then GB removal should be considered.
Right now, all you need is regular 6 monthly follow up with imaging in reliable hands.
For your fibroids, medical therapy with cyclical progesterone tablets / GnRH injections / Danazol etc can be tried.
Generally fibroids shrink after menopause, so it is best to follow up both things with regular imaging.
Take care


Dr. Aarti Vazirani
Category: Infertility Specialist
Experience: 
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
Dr. Aarti Vazirani and 4 other Medical Specialists are ready to help you

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