Hemorrhagic uterine necrosis after surgical vessel ligation and B-Lynch suture in persistent post-cesarean uterine atony: case report and review of literature

Giusti, Sabina; Fanti, F.; Cecchi, Elena; Capriello, P.; Malacarne, Elisa; Marmorato, M.; Vergine, Francesca; Giannini, Andrea; Gadducci, Angiolo; Caramella, Davide; Simoncini, Tommaso

doi:10.18203/2320-1770.ijrcog20163887

Cited by 1 publication

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“…Interpretation of presence of gas bubbles in the myometrium on USG and CT, MRI is essential for arriving at diagnosis. 8,13 This was initially missed in this woman by MRI, and misinterpretation was that of a foreign body. The management has been laparotomy and hysterectomy in the cases reported literature.…”

Section: Discussionmentioning

confidence: 94%

“…The management has been laparotomy and hysterectomy in the cases reported literature. [8][9][10][11][12][13] Reports regarding conservative management of uterine necrosis are sparse, but in a recent publication, necrosis was diagnosed preoperatively by CT 10 days after caesarean section, and the woman was managed by laparotomy, excision of the necrotic margins of the ruptured uterine incision, and suturing after draining the pus. 14 In the present woman, there was no dehiscence of the uterine incision, and the necrosis involved the body of the uterus.…”

Section: Discussionmentioning

confidence: 99%

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Conservative management of uterine necrosis following bilateral uterine vessels ligation and B-Lynch suture: Long term follow up

Dasari

2022

IJOGR

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A 29-year-old second gravida, previous abortion with twins, was induced at 32 weeks because of severe pre-eclampsia. Emergency caesarean section was needed for the second of twins, at which time she had an atonic postpartum haemorrhage. Bilateral uterine vessel ligation followed by B-Lynch suture was undertaken due to failure of medical measures. Post-operatively she had a stormy course with high spiking temperature and distension of abdomen and on imaging suspected foreign body in the uterus or uterine necrosis. At laparotomy, there was 6 liters of foul-smelling peritoneal fluid, and there was a deep groove on the uterus with impending perforation and partial necrosis of the uterus. After removing the suture, the perfusion slowly resumed, and hysterectomy was deferred. After five months, she expelled a necrotic tissue of the uterine cast. After six months, she resumed menstruation, and after three years, she had an intrauterine pregnancy, and presently, at five years, she has regular menstruation.

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Section: Discussionmentioning

confidence: 94%