Acute rectal ischaemia after bilateral uterine artery embolization and urgent hysterectomy to treat massive bleeding

Introduction: This is the first case of total rectal and anal canal necrosis following uterine arteries embolization described in the literature.

Presentation of case: A 34 year-old woman suffered from massive Post Partum Haemorrhage. A vascular surgeon performed bilateral uterine arteries embolization with absorbable gelatin sponge which did not allowed a sufficient control of the bleeding, leading to hysterectomy. Perineal gangrene was diagnosed on day 10 on CT scan, pelvic MRI, and rectosigmoidoscopy. The etiology was a rectal ischaemia going from the level of the second sacral vertebra to the anal canal. Drainage and a lateral laparoscopic sigmoidostomy were associated to antibiotherapy.

Discussion: Ornan et al. described complications of bilateral uterine arteries embolization in a serie of 28 patients with post partum haemorrhage. One of these patients presented a necrotic segment of small bowel 7 days after the embolization, she required a surgery. The hypothesis for these kinds of complications is the migration of the gelatine sponge particles.

Conclusion: This rare but life-threatening complication has never been reported before and should be known when considering perineal pain after bilateral uterine arteries embolization.