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Septic uterus after uterine artery embolization for uterine myomas triggered by endometrial biopsy
Shauna L Reinblatt1, Srinivasan Krishnamurthy1, David Valenti1
1Department of Obstetrics and Gynecology, and Radiology, McGill University, Montreal QC.
Background:
Women who undergo uterine artery embolization (UAE) and subsequently have heavy vaginal bleeding require assessment to establish the cause. Endometrial sampling in such women should not necessarily carry more than the usual risk.
Cases:
Two women who had undergone UAE presented with recurrence of heavy vaginal bleeding. In order to rule out possible endometrial malignancy, we performed an endometrial biopsy. Both patients had large and necrotic intramural myomas adjacent to the endometrium. They developed septic uterus shortly after endometrial biopsy and each required a hysterectomy. The postoperative course in the first case was complicated by deep vein thrombosis and enterovaginal fistula.
Conclusion:
Because of the high risk of infection, women with a history of UAE and necrotic myoma adjacent to the endometrium should not undergo endometrial biopsy. We recommend evaluation of the relation of myomas to the endometrium.