Conservative Laparoscopic Approach to a Perforated Pyomyoma After Uterine Artery Embolization

Pyomyoma Following Uterine Artery Embolization (UAE) – Dual Case Report and Review of Literature

“…Postembolization syndrome (PES) consists of abdominal pain, nausea, vomiting and fever that usually subsides after the first few days of onset. The presence of intrauterine infection and exclusion of PES can be determined on the basis of one or more of the following: presence of foul-smelling vaginal discharge, presence of high-grade leukocytosis, clinical course of the initial symptoms (PES occurs within a few days of UAE), and clinical improvement with therapy [7,8]. The manifestation of pyomyoma can be subtle, developing within days or weeks after a procedure, as in the cases that we presented.…”

“…The manifestation of pyomyoma can be subtle, developing within days or weeks after a procedure, as in the cases that we presented. Differentiation of PES with acute fibroid degeneration versus those of intrauterine fibroid infection and pyomyoma formation may be difficult clinically due to non specific signs and symptoms [7,8,11,20]. In high-risk patients who present with symptoms of abdominal pain and fever after the first week of UAE, pyomyoma must be considered, and appropriate therapy must be offered [8].…”

“…Among the articles reviewed some authors maintain that the clinical triad of pyomyoma is the presence of leiomyoma uteri, sepsis or bacteremia and the absence of other sources of infection [7,8]. One study showed that these criteria are not always reliable as patients failed to be diagnosed half the time [18].…”

“…There are many medical and surgical treatment modalities to treat fibroids including, but not limited to Oral contraceptive Pills (OCPs), Gonadotropin-Releasing Hormone (GnRH) agonists, myomectomy, and hysterectomy. Notably a popular treatment modality for symptomatic leiomyomas is that of the minimally invasive Uterine Artery Embolization (UAE) [2][3][4][5][6][7].…”

“…Supplemental metal coils can also be used to assist in arterial occlusion [2]. The result is the devascularization and involution of the leiomyoma [2][3][4][5][6][7]. One study showed that minor post-op complications including vaginal discharge, leiomyoma expulsion, and hematoma formation were higher in groups that had UAE when compared to groups that had Hysterectomy (58% vs 40%) as well as higher readmission rates (11.1% vs 0%).…”