Clinical Lessons From a Case of Retained Non-absorbable Suture After Uterine Compression

Abstract

Postpartum bleeding is commonly addressed with uterine compression using absorbable sutures; however, possible complications associated with non-absorbable threads are not well documented. We present a case in which a non-absorbable thread was mistakenly used to perform uterine compression sutures to treat postpartum uterine bleeding. Non-invasive methods, such as magnetic resonance imaging and hysteroscopy, failed to assess the sutures. As the patient wanted to have another child, diagnostic laparoscopy was performed one year later; the suture thread was still present, and a gap had formed between the thread and uterus, posing a risk for intestinal obstruction. The suture thread was successfully removed, and fertility treatment was resumed. This case highlights the dangers of using a non-absorbable thread for uterine compression sutures and the importance of promptly removing these sutures to avoid complications. Simulation training and pre-prepared suture materials are essential to prevent such errors. This case highlights the clinical risks associated with the use of non-absorbable sutures for uterine compression and the necessity of prompt identification and intervention to protect reproductive health.

Keywords: complication; non-absorbable suture; non-absorbable thread; postpartum hemorrhage; uterine atony; uterine compression suture.

Figure 1. Uterine compression suture using a non-absorbable thread.

(a) Uterine compression suture technique partially based on the Matsubara–Yano method. A needle was inserted through the anterior uterine wall slightly above the uterine incision and passed through the posterior wall, and a strong compression suture was placed at the uterine fundus to compress the uterus. The procedure was performed bilaterally. To prevent the sutures from slipping laterally, an additional suture was placed in the lower uterine segment (yellow arrow). No sutures were applied to the upper uterine body, as the myometrial layer in this area was too thick to allow safe needle passage. (b) Absorbable thread (left) and non-absorbable thread (right). Both had similar straight needles.

Figure 2. Evaluation of non-absorbable sutures using non-invasive methods.

(a, b) T2-weighted MRI images six months postoperatively. Low-signal images indicating hemosiderin deposition were observed at the locations where the compression sutures had been placed; however, the sutures were not visible. (c-e) Hysteroscopic images taken one year postoperatively. (c) No obvious abnormal findings were observed in the area around the right fallopian tube opening. (d) No adhesions or sutures were observed in the uterine cavity. (e) No obvious abnormalities were observed in the area around the left fallopian tube opening.

Figure 3. Findings of diagnostic laparoscopy.

(a, b) The thread remained in the same condition as it was at the time of application. (c) A large space was formed between the uterus and the suture thread, posing a risk of the intestinal tract becoming embedded within it.