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Necrotic Leiomyoma and Gram-Negative Sepsis Eight Weeks After Uterine Artery Embolization

¹Department of Obstetrics and Gynecology, David Grant Medical Center, Travis Air Force Base, California; ²Department of Interventional Radiology, University of California, San Francisco, California; ³Department of Obstetrics and Gynecology, Kaiser Permanente, Vallejo, California.

Address reprint requests to: Matthew Aungst, Captain, 60 MSGS/SGCG, 101 Bodin Circle, Travis AFB, CA 94535; e-mail: Mathew.aungst{at}60mdg.travis.af.mil.

BACKGROUND: Uterine artery embolization for symptomatic leiomyomata is generally safe, but rare life-threatening complications, including sepsis, can result.

CASE: A 39-year-old woman with primary antiphospholipid syndrome, who was on chronic warfarin therapy, underwent uterine artery embolization for severe menorrhagia and a 12-cm intracavitary leiomyoma. Eight weeks postembolization, the patient, who had been essentially asymptomatic, presented in septic shock from gram-negative anaerobic bacteria. She underwent hysterectomy and bilateral salpingo-oophorectomy for a large infarcted necrotic leiomyoma and partial uterine necrosis. The patient's 8-day hospitalization required extended care in the intensive care unit and blood transfusion and resulted in surgical menopause in a patient who is not a candidate for hormone therapy.

CONCLUSION: Uterine artery embolization is a procedure not without significant risks. From published case reports, it appears that patients most at risk for severe infection of an infarcted leiomyoma after this procedure are those with a large dominant leiomyoma.

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