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Uteroenteric Fistula Resulting From Fibroid Expulsion After Uterine Fibroid Embolization: Case Report and Review of the Literature

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Abstract

A 44-year-old woman underwent uncomplicated uterine fibroid embolization (UFE) for menstrual and bulk-related symptoms in an enlarged, myomatous uterus. After surgery, she spontaneously sloughed a large mass of fibroids that arrested in the cervical canal during passage. Four days after gynecological extraction, she developed copious vaginal discharge that contained enteric contents. Contrast-enhanced computed tomography (CT) demonstrated a fistula between the small bowel and the uterus. She subsequently underwent hysterectomy, left oophorectomy, and small-bowel resection. Her postoperative recovery was uneventful.

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Authors and Affiliations

  1. School of Medicine, Stanford University, Stanford, CA, 94305-5101, USA

    Luis B. Gutierrez & David M. Hovsepian

  2. Department of Radiology, University of California at Los Angeles, Los Angeles, CA, 90049, USA

    Anshuman K. Bansal

Authors
  1. Luis B. Gutierrez
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  2. Anshuman K. Bansal
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  3. David M. Hovsepian
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Corresponding author

Correspondence to David M. Hovsepian.

Appendix

Appendix

See Fig. 5.

Fig. 5
figure 5

Symptoms of fibroid expulsion after UFE are nonspecific and include abdominal cramps, fever, and vaginal discharge, which may occur during the postoperative period in the absence of a fibroid being expelled. When expulsion does occur, the cervix must dilate, which potentially allows vaginal flora to ascend and infect the devascularized fibroid tissue, possibly the endometrium, and could lead to life-threatening complications. The algorithm used by our institution covers a 3-day period after the initial presentation. A outlines the first day, and triage is based on whether the patient is febrile and, if so, to what degree. Mildly symptomatic patients can usually be managed at home without the need for admission to the hospital. Antibiotic treatment should be initiated immediately in febrile patients along with anti-inflammatory medication to ease the cramps, which can be severe. High fever warrants admission for intravenous therapy and observation. If symptoms persist into a second day (B), then even a mild temperature increase may be concerning, and consideration should be given to observation in the hospital and to exchanging oral medications for intravenous ones. For patients admitted on the previous day, if expulsion seems likely to be occurring, then an MRI or speculum examination may be indicated. If there are continued fever and cramps beyond 48 h (C), despite adequate intravenous medications, they warrant imaging and possibly urgent intervention depending on how ill the patient appears. For those patients who have defervesced after the initiation of intravenous medications, discharge to home on a 7- to 10-day course of oral antibiotics and anti-inflammatory medication may be considered at this point

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Gutierrez, L.B., Bansal, A.K. & Hovsepian, D.M. Uteroenteric Fistula Resulting From Fibroid Expulsion After Uterine Fibroid Embolization: Case Report and Review of the Literature. Cardiovasc Intervent Radiol 35, 1231–1236 (2012). https://doi.org/10.1007/s00270-011-0318-4

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  • DOI: https://doi.org/10.1007/s00270-011-0318-4

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