Fatal septicaemia after fibroid embolisation

Massive vault necrosis with bladder fistula after uterine artery embolisation

“…To date, two deaths due to sepsis have been reported in association with embolisation of the uterine arteries 14,15 . Due to acute ischaemia following embolisation, a syndrome of diffuse abdominal pain, fever and leucocytosis has been reported.…”

Is Embolization Equal to Hysterectomy in Treating Uterine Fibroids?

“…Two deaths from uterine infection and overwhelming sepsis have also been reported after UAE (de Block et al, 2003;Vashist et al, 1999). Clinical experience and evidence from a case report (Vashist et al, 1999) suggest that infection may originate from the vagina and/or the urinary tract, which underlines the importance of preprocedure screening for genitourinary infection. There is also evidence that certain preexisting conditions, such as a coexistent adnexal pathology (Nikolic et al, 2004), and some minor post-procedure complications, in particular fibroid expulsion (Marret et al, 2004;Spies et al 2002b), are associated with a higher risk of infection.…”

“…Sepsis is more frequent when UAE is performed on a very large uterus; more than 20 cm in height, when a single fibroid is larger than 9 cm in diameter or when there is a large submucous fibroid (Aungst et al, 2004;Nikolic et al, 2004). Two deaths from uterine infection and overwhelming sepsis have also been reported after UAE (de Block et al, 2003;Vashist et al, 1999). Clinical experience and evidence from a case report (Vashist et al, 1999) suggest that infection may originate from the vagina and/or the urinary tract, which underlines the importance of preprocedure screening for genitourinary infection.…”

“…There is also evidence that certain preexisting conditions, such as a coexistent adnexal pathology (Nikolic et al, 2004), and some minor post-procedure complications, in particular fibroid expulsion (Marret et al, 2004;Spies et al 2002b), are associated with a higher risk of infection. In addition to two deaths from septic shock (de Block et al, 2003;Vashist et al, 1999), other three deaths following UAE have thus far been reported, one from pulmonary embolism and two from uncertain causes (Worthington-Kirsch et al, 2005), in more than 100 000 procedures performed worldwide. If we assume that all these deaths were related to the procedure, the mortality risk would be 0.05:1000, which compares favourably with the estimated mortality rate of 0.38:1000 following hysterectomy for non-obstetric benign disease (Maresh et al, 2002;Siskin et al, 2002;Vashist et al, 1999).…”

“…In addition to two deaths from septic shock (de Block et al, 2003;Vashist et al, 1999), other three deaths following UAE have thus far been reported, one from pulmonary embolism and two from uncertain causes (Worthington-Kirsch et al, 2005), in more than 100 000 procedures performed worldwide. If we assume that all these deaths were related to the procedure, the mortality risk would be 0.05:1000, which compares favourably with the estimated mortality rate of 0.38:1000 following hysterectomy for non-obstetric benign disease (Maresh et al, 2002;Siskin et al, 2002;Vashist et al, 1999). An ischemic injury to the uterus of such severity necessitating hysterectomy is required in less than 1% of patients.…”