Buttock necrosis after hypogastric artery embolization for postpartum hemorrhage

Abstract

Background: Uterine or hypogastric artery embolization is a useful alternative to hysterectomy in the treatment of postpartum hemorrhage. Case: Puerpera requiring a bilateral hypogastric artery embolization for postpartum hemorrhage after cesarean section in a term twin pregnancy. Unexpected unilateral buttock necrosis appeared 5 days later. Treatment consisted of debridement, the use of vacuum-assisted closure therapy and skin grafting. Conclusion: Buttock necrosis is a rare complication after hypogastric artery embolization in the treatment of postpartum hemorrhage.

Buttock necrosis following uterine artery embolization: A case report

“…Although uterine artery embolization is being done more commonly nowadays for women with symptomatic fibroid disease, significant and potentially life-threatening complications continue to occur [9] . There have been other reported cases of necrosis following UAE [10] , [11] , [12] , [13] . A case report by Danielle M Dietz et al described a woman with fibroid who had uterine artery embolization following which she developed two areas of full thickness necrosis on her right buttock [10] .…”

“…Similarly, Devin D. Smith et al reported a 39-year-old pregnant lady who developed right buttock necrosis following uterine artery embolization for delayed hysterectomy in placenta percreta [11] . Robin Julve et al described unexpected unilateral buttock necrosis five days following hypogastric artery embolization for postpartum hemorrhage [12] . The article by Anne-Sophie Didnée, Jr. et al is yet another example of acute rectal ischemia following uterine artery embolization to treat postpartum hemorrhage [13] .…”

“…From the above-mentioned cases, it is clear that buttock necrosis is an established complication which is highly possible following uterine artery embolization. The most likely mechanism of this necrosis is the reflux of embolic material from the uterine artery to the inferior gluteal artery [12] .…”