LARGE UTERINE FIBROID ACCOMPANIED BY 
PREGNANCY. 
Reported by James B. Eagleson M. D. Seattle Wash. 
The following case is reported on account of several intorest- 
ing points which it presents, both clinical and pathological. 
Mrs. G. S., aged 42 years, was admittel to the Seattle Gen- 
eral Hospital January 13th, and gave the following history. 
T.iere was nothing out of the ordinary i:i her pro-menstrual his- 
tory, and she had always enjoyed excellent health up to the birth 
of her daughter, now sixteen years old, after which no other 
pregnancy occurred. A few years after the childbirth her men- 
strual flow began to be more profuse than was normal with her, 
and gradually increased until two years ago, when it became quite 
excessive and began to affect her gener.il health. About this time 
she also noticed an enlargement over the womb which led her to 
consult a physician regarding her condition. He pronounced it a 
fibroid tumor of the womb, and advised her to let it alone, unless 
it should cause her more trouble by increasing in size or increased 
menorrhagia. He evidently thought that at her age there was 
some hope for an early menopause which might check the devel- 
opment of the tumor. 
Its growth continued to be slow and gradual and it gave her 
little inconvenience aside from the general debilitated condition, 
until about three months before coming to the hospital, when it 
began to increase in size quite rapidly and was at times very 
painful. The menstrual flow had gradually diminished for 
several months, and for the past three, had ceased entirely, this 
was taken to be the approaching menopause. During these three 
months her general health had declined very rapidly. For three 
weeks before leaving homt> she noticed a slight afternoon rise of 
temperature but at no time did she experience any rigors wTbich 
might indicate the formation of pus. 
On physical examination she was found to be quite weak and 
emaciated. There was an abdominal tumor present which in- 
creased her siz3 to that of a seven months pregnancy. Palpa- 
tion revealed it to be a very firm and elastic tumor, (most prob- 
ably a solid growth) very nodular and irregular in outline, and 
much more prominent on the right side where it extended up- 
ward and outward above the crest of the ilium. There was also 
quite a large nodule in the median line and a little to the left of 
it, above the body of the uterus which was frnely movable and 
was evidently attached to it by a long pedicle. The tumor was 
very tender to the touch over its whole area but especially on the 
right side, which was the seat of the severe pain that she suffer- 2 
ed at times. On vaginal and rectal examination the tumor ap- 
peared to fill the upper part of the pelvic cavity and by its press- 
ure caused considerable interference with the normal action of 
both bladder and rectum. 
The diagnosis arrived at was that of a large multiple uterine 
fibroid with localized peritonitis. It was decided to remove it by 
an abdominal hysterectomy, which operation was performed Jan- 
uary 19th. 
The patient came from the operating table in a very weak 
condition from which she did not rally and died at the end of 
forty eight hours, apparently from exhaustion and general weak- 
ness, hastened by the shock of the operation. 
On opening the abdominal cavity we found that the uterus, 
together with the mass of fibroids involving it, had made almost 
a complete half turn to the right on the axis of the uterine canal. 
The largs mass on the right side which projected up under the 
margin of the liver was a large cylindrical shaped fibroid growing 
from the anterior wall of the uterus, and as it increased in size, 
had gradually forced its way into this position for want of room to grow in any other direction. The torsion thus produced had 
brought the left ovary and tube over to the right side of the 
median line, and the right one had been forced around behind the 
uterus to the left side. It had become cystic, forming one 1 irge 
cyst the size of an orange, and was filled with broken down blood 
from, an old haemorrhage into it. It was this ovarian cyst which 
was felt on palpation through the abdominal wall as a peduncu- 
lated nodule above the uterus. The broad and long ligaments 
3 
were much elongated as a result of the torsion, so that it was very 
easy to ligate them with their accompanying vessels. 
The cyst of the right ovary was accidentally ruptured during its 
removal and was found to be full of the remains of an old blood 
clot resulting from a haemorrhage into the cyst cavity. 
The outer end of the large nodule on the anterior uterine 
wall was quite soft and an incision into it revealed a cavity con- 
taining broken down tissue and pus. This abscess formation no 
doubt accounted for the elevation in temperature for some time 
before the operation. 
When the uterine cavity was opened by an incision through 
the fundus we were very much surprised to find that it contained 4 
an emaciated foetus of about four months development. Prior to 
this time pregnancy had not been suspected in the case. 
The accompanyinsr cuts will give a much more accurate ideu 
of the specimen than can be gained by the ve-bal description 
Plate I. gives an anterior, view of the uterus which is held in 
an upright position by a heavy wire passed into the cervix. 
Plate II. gives a posterior view. 
Plate III. gives a viewr of the left side thus showing a profile 
of the large nodules protruding from the anterior and posterior 
walls. 
Figure 1, is the cervix. Fig. 2. the abscess cavity in the an- 
terior nodule. Fig. 3, the sac of the right ovarian cyst. Fig. 1 
the left ovary and tube. Fig. 5, the nodule on the posterior wall. 
Fig. 6, the incision in the fundus through which the foetus was 
extracted. Fig. 7, the foetus. These figures refer to the same 
points on each of the plates.