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Case Reports
. 2023 Dec 1;142(6):1509-1512.
doi: 10.1097/AOG.0000000000005406.

Leiomyoma Fistulization After Uterine Artery Embolization

Lulu Yu  1 , Ziho Lee, Oluwateniola Brown, Linda C Yang
Affiliations
Case Reports

Leiomyoma Fistulization After Uterine Artery Embolization

Lulu Yu et al. Obstet Gynecol. .

Abstract

Background: Uterine artery embolization (UAE) has been used to treat symptomatic uterine leiomyomas since 1995. This case report describes a rare complication of UAE, with delayed recognition, ultimately requiring definitive hysterectomy.

Case: A 53-year-old women with symptomatic leiomyomas underwent imaging demonstrating an enlarged (16.9×11.3×11.5 cm) uterus with multiple leiomyomas. She underwent UAE and, over the subsequent 3 months, and had five emergency department visits for abdominal pain and dysuria. Pelvic magnetic resonance imaging (MRI) 4 months postprocedure showed nodular mural enhancement of the right anterior bladder dome, and cystoscopy demonstrated irregular tissue on the right dome of the bladder. The patient ultimately underwent total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, partial cystectomy with reconstruction, and omental flap for bladder necrosis and leiomyoma fistulization.

Conclusion: Bladder necrosis and leiomyoma fistulization are rare complications of UAE that can present with pelvic pain, hematuria, and recurrent bladder stones. Computed tomography and MRI can be useful tools in evaluating for complications, but clinicians should have a low threshold to use cystoscopy to directly visualize potential abnormalities identified on imaging. Patients with complex cases with suspected post-UAE complications warrant referral to tertiary care centers for a multidisciplinary approach.

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Conflict of interest statement

Financial Disclosure Ziho Lee reports receiving payment from Boston Scientific and Intuitive Surgical. The other authors did not report any potential conflicts of interest.

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