Uterine fistula induced by hysteroscopic resection of an embolized migrated fibroid: a rare complication after embolization of uterine fibroids

Hysteroscopy after uterine fibroid embolization: Evaluation of intrauterine findings in 127 patients

“…While the risk of ovarian failure after UAE is quite low, especially in younger patients, the incidence of intrauterine abnormalities associated with UAE is significantly higher 5,6,8,22 . Moreover, the gravity of some post‐embolization findings (intracavitary myoma protrusion, fistula between uterine cavity and intramural myoma, intrauterine synechiae) diagnosed by hysteroscopy makes successful pregnancy hardly imaginable 4,6,7,9 . It corresponds well with a high percentage of early pregnancy loss after UAE reported by some authors 10–12 .…”

“…Intrauterine regressive changes have also been found in six patients with completely normal pre‐UAE hysteroscopy (Table 2). Migration of the embolized fibroids through the muscular layer of the uterine wall is a probable explanation 4 . Even though complete necrosis is a fairly common histological finding in myomas removed after pregnancy by laparoscopy or laparotomy, it is interesting and difficult to explain why we have never seen regressive changes similar to post‐UAE findings in these patients on hysteroscopy.…”

“…Even though it is considered a minimally invasive therapy, it bears many possible complications, which can be serious, especially in women with reproductive plans. Compared to infection and ovarian failure, which is seen rarely in patients younger than 40 years of age, intrauterine macroscopic as well as histopathological abnormalities are observed more frequently using hysteroscopy and uterine cavity biopsy 4–9 . The presence of intrauterine pathologies might be associated with higher risk of early pregnancy loss in patients after UAE 10–12 .…”

“…Compared to infection and ovarian failure, which is seen rarely in patients younger than 40 years of age, intrauterine macroscopic as well as histopathological abnormalities are observed more frequently using hysteroscopy and uterine cavity biopsy. [4][5][6][7][8][9] The presence of intrauterine pathologies might be associated with higher risk of early pregnancy loss in patients after UAE . [10][11][12] The aim of the present study was to examine the frequency and type of post-embolization hysteroscopic findings in a large and homogenous group of patients.…”

Uterine fibroid embolization (UFE)

“…The physical characteristics, integrity, and the histopathologic features of the uterine wall after uterine artery embolization remain unknown. Uterine wall defects [40], uterine fistula [41], and 1 case of diffuse uterine necrosis [42] following uterine artery embolization have been reported. Although normal pregnancies and deliveries following uterine artery occlusion have been reported, there is insufficient long-term data regarding reproductive outcome following this procedure and it would be prudent to reserve embolization for women who will not wish pregnancy [26,27,43].…”