Puerperal Uterine Necrosis and Pyometrium After Uterine Artery Embolization [27L]

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Abstract

INTRODUCTION:

Uterine necrosis is a rare complication following uterine artery embolization.

METHODS:

We report a case of uterine necrosis in a 32 year old primigravida patient who underwent uterine artery embolization for postpartum hemorrhage.

RESULTS:

This patient presented in labor at term and had a spontaneous vaginal delivery. Her labor was complicated by chorioamnionitis, which was treated appropriately. Her history was remarkable for a 6.9 × 5.4 × 6.8 cm posterior submucosal fibroid. Postpartum course was significant for hemorrhage secondary to atony and retained placenta, which was manually extracted. Bakri balloon placement was attempted, but unsuccessful due to obstruction from the fibroid. She subsequently underwent an uncomplicated uterine artery embolization, and was discharged on postpartum day 3. She re-presented on postpartum day 10 for fevers to 103°F, and was admitted for presumed endometritis. Appropriate antibiotics were started, however she continued having recurrent fevers through hospital day 9. Computed tomography scan revealed gas and fluid within the uterine cavity, and endometrial biopsy showed heavy growth of E. coli. She underwent an abdominal hysterectomy, and was found to have a 20 weeks sized uterus with a 6 cm submucosal fibroid with blood-tinged purulent contents. Histology was consistent with pyometrium and uterine necrosis.

CONCLUSION:

Uterine necrosis is a rare, but serious complication of uterine artery embolization when used for postpartum hemorrhage. Recognizing risk factors and understanding rare complications can help providers better counsel patients and prevent delays in care when patients re-present with fevers refractory to conventional treatment.

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