Uterine necrosis following a combination of uterine compression sutures and vascular ligation during a postpartum hemorrhage: A case report

Abstract

HighlightsAfter failure of medical treatment and triple vascular ligation, a combination of technique can be used, and very little article in the literature discusses the modalities of this combination to avoid Uterine Necrosis.We emphasize the importance of choosing surgical techniques that lead to the preservation of uterine vascularization.The preference is to triple ligation distal type Tsirulnikov supplemented if necessary by a B-Lynch.After the use of uterine compression sutures, the patient requires maximum caution and monitoring for complications, the most serious of which is uterine necrosis.

Uterine necrosis simulating a textiloma: A case report

“…At this point, the diagnosis requires further exploration by CT scan or MRI if available which remains the investigation of choice. The CT scan is highly useful for the diagnostic as it demonstrates the presence of gas in the myometrium, the absence of enhancement of the myometrium after injection of contrast product associated with uterine enlargement, free fluid in the peritoneal space is usually seen [5] , [6] .…”

Uterine compression sutures with additional hemostatic procedures for the management of postpartum hemorrhage

“…38 Other factors that may increase the risk of uterine necrosis include an excessively tight suture, overdistension of uterus by hematometra, incorrectly placed sutures, and finally, a combination with another hemostatic modality. 26,39 The diagnosis of uterine necrosis by ultrasound scan is difficult. The very unusual uterine echotexture may mimic retained products of conception.…”

“…Although there are no trials to assess the correct choice of suture material, a firm, monofilamentary and readily absorbable stitch is considered the best material to reduce the potential damage to uterine wall 38 . Other factors that may increase the risk of uterine necrosis include an excessively tight suture, overdistension of uterus by hematometra, incorrectly placed sutures, and finally, a combination with another hemostatic modality 26,39 . The diagnosis of uterine necrosis by ultrasound scan is difficult.…”

Post-Cesarean Peritonitis Caused by Hysterorrhaphy Dehiscence with Puerperal Acute Abdomen Syndrome

“…Active postpartum hemorrhage from the described vein caused dehiscence of the medial part of the hysterorrhaphy and consequently the formation of a retrovesical hematoma and secondary anemia. The tightened, locked-suture uterotomy caused ischemia and then necrosis of the focal part of the myometrium with the appearance of initially localized inflammation -myometritis -and was then aided by secondary anemia and propagation of uterine puerperal contents into localized peritonitis [8][9][10]. Laboratory tests were dominated by the already high CRP values, which are explained by the 'contribution' from the recent cesarean section but also to a larger extent by the development of a secondary inflammatory condition.…”