Buttock necrosis following uterine artery embolization: a case report

Uterine artery embolization (UAE) is an increasingly common procedure for the management of uterine leiomyoma (fibroid). Up to 70% of White women and more than 80% of women of African ancestry will develop benign fibroid tumors of the uterus, many of whom will have symptoms including increased menstrual bleeding, urinary symptoms, pain, and infertility. When medical management does not adequately treat symptoms, UAE is a minimally invasive surgical treatment option. Nontarget embolization is a rare complication of this procedure and can result in soft tissue necrosis. Few case reports describe this phenomenon.

A 46-year-old female presented to the wound clinic 5 months after UAE. Following this procedure, the patient developed burning pain in the thigh and buttock. After 5 weeks, a small eschar formed over the right buttock, which progressed to a large necrotic ulceration. The patient was treated successfully, with wound closure by secondary intention occurring 24 weeks after initial presentation. Treatment included sharp debridement, advanced dressings, oral antibiotics (for infection), and negative pressure wound therapy.

This case adds to the body of literature describing a full-thickness wound forming due to nontarget embolization. The patient was treated successfully in clinic without the need for further surgery or inpatient treatment.