Chandrasekaran Savitri, Antakia Ramez, Olugbemi Mojolaoluwa
West Suffolk Hospital, Hardwick Ln, Bury St Edmunds IP33 2QZ, United Kingdom.
Int J Surg Case Rep. 2023 Jan;102:107833. doi: 10.1016/j.ijscr.2022.107833. Epub 2022 Dec 6.
Fibroid is a very common benign tumor of the uterus for which uterine artery embolization is one of the treatment modalities of choice. Uterine artery embolization (UAE) is a minimally invasive procedure used in the management of fibroids, nowadays mostly performed by interventional radiologists. A rare complication of the procedure is buttock necrosis which has been observed in this case. If not identified at an early stage, it may result in extensive damage to a large surface area of the skin hence this case report is of clinical relevance as it is essential to be aware of the complications of UAE and be cautious.
Our report is regarding a 37-year-old female who presented to the emergency department with a gradually increasing excruciatingly painful lesion on the left buttock 12 days after undergoing a uterine artery embolization. Examination revealed a necrotic lesion involving 40 % surface area of the left buttock.
There are a few other such cases reported in literature. All these cases, including ours, prove that buttock necrosis is an established complication which is highly possible following uterine artery embolization. This complication is likely due to reflux of embolic material into gluteal artery.
This case warranted extensive debridement and plastic surgery referral for skin grafting. Although a rare scenario, being a dangerous and distressful one for patients, ability to recognize this complication at an early stage will aid in the management and mental well-being of the patient.
子宫肌瘤是一种非常常见的子宫良性肿瘤，子宫动脉栓塞术是其首选治疗方式之一。子宫动脉栓塞术（UAE）是一种用于治疗子宫肌瘤的微创手术，如今大多由介入放射科医生进行操作。该手术的一种罕见并发症是臀部坏死，本病例中观察到了这种情况。如果早期未被识别，可能会导致大面积皮肤的广泛损伤，因此本病例报告具有临床相关性，因为了解UAE的并发症并保持谨慎至关重要。
我们的报告涉及一名37岁女性，她在接受子宫动脉栓塞术后12天因左侧臀部逐渐出现剧痛性病变而就诊于急诊科。检查发现左侧臀部有一个坏死病变，累及40%的表面积。
文献中还报道了其他一些此类病例。所有这些病例，包括我们的病例，都证明臀部坏死是子宫动脉栓塞术后极有可能出现的一种既定并发症。这种并发症可能是由于栓塞物质反流至臀动脉所致。
该病例需要进行广泛清创并转诊至整形外科进行皮肤移植。尽管这种情况罕见，但对患者来说既危险又痛苦，早期识别这种并发症的能力将有助于患者的治疗和心理健康。
