Necrotising soft tissue infection following myomectomy: a devastating postoperative complication

Area of Science:

• Gynecologic Surgery
• Reproductive Medicine
• Infectious Diseases

Background:

• Abnormal uterine bleeding due to fibroids often necessitates surgical intervention like myomectomy.
• Fertility preservation is a key consideration for women undergoing myomectomy.
• Surgical site infections following myomectomy can have severe consequences.

Purpose of the Study:

• To report a rare case of uterine loss due to severe infectious complications after abdominal myomectomy.
• To underscore the critical need for improved antibiotic prophylaxis guidelines for myomectomy procedures.
• To highlight the potential for devastating outcomes, including infertility and death, from post-myomectomy infections.

Main Methods:

• Case report of a multiparous woman in her mid-40s.
• Abdominal myomectomy performed for abnormal uterine bleeding and fertility preservation.
• Management of postoperative infectious complications including parenteral antibiotics and hysterectomy.

Main Results:

• The patient developed an abdominal wall abscess and necrotizing soft tissue infection post-myomectomy, despite prophylactic antibiotics.
• Severe infection led to the loss of the uterus, requiring a supracervical hysterectomy with bilateral salpingo-oophorectomy.
• The patient experienced infertility and surgical menopause as a consequence.

Conclusions:

• Current guidelines for surgical site infection prophylaxis in myomectomy are insufficient.
• Further high-quality clinical trials are essential to establish definitive antibiotic prophylaxis recommendations.
• Inadequate infection control during myomectomy can result in severe morbidity, including loss of fertility and potentially life-threatening complications.