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Unexpected outcome (positive or negative) including adverse drug reactions
CASE REPORT
An unexpected complication following uterine artery embolisation
  1. Sarah Peters1,
  2. Michelle Wise2,
  3. Brendan Buckley3
  1. 1Department of Obstetrics and Gynaecology, Auckland District Health Board, Auckland, New Zealand
  2. 2Deaprtment of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
  3. 3Department of Interventional Radiology, Auckland District Health Board, Auckland, New Zealand
  1. Correspondence to Dr Michelle Wise, m.wise{at}auckland.ac.nz

Summary

A 35-year-old nulliparous woman underwent uterine artery embolisation (UAE) for heavy menstrual bleeding and anaemia due to fibroids, refractive to medical and surgical treatment.

Bilateral UAE was performed after cephazolin prophylaxis and analgesia. Postoperatively, pain and abdominal bloating were prominent. Symptoms were initially treated as postembolisation syndrome, and analgesia was escalated. By the third day, pain was worsening and the woman developed marked tachypnoea and tachycardia, with raised inflammatory markers and lactate. An abdominal X-ray and CT showed dilated colon. A colonoscopy demonstrated severe mucosal ulceration down to the muscular layer.

A subtotal colectomy and end ileostomy formation was performed with intraoperative findings of toxic megacolon with near perforation. The cause of the toxic megacolon, in the absence of previous bowel pathology, was attributed to pseudomembranous colitis as a consequence of single dose prophylactic antibiotic.

  • reproductive medicine
  • interventional radiology
  • gastrointestinal surgery
  • nosocomial infections

https://doi.org/10.1136/bcr-2016-217238

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    Footnotes

    • Contributors Each author has made a substantial contribution to this study. SP conceived of and designed the study, acquired the data, performed a literature search, drafted the manuscript and interviewed the patient. MW interpreted the data and critically revised the manuscript. BB contributed relevant studies for the Discussion, interpreted the data, critically revised the manuscript and supplied the images. Each author has approved this final version of the manuscript.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.