title: Incomplete vaginal expulsion of pyoadenomyoma with sepsis and focal bladder necrosis after uterine artery embolization for symptomatic adenomyosis: case report.
abstract: The major complications secondary to uterine artery embolization (UAE) are rare. We report a case involving a patient who underwent UAE for symptomatic adenomyosis, and experienced complications including incomplete vaginal expulsion of a large focal pyoadenomyosis, sepsis and focal bladder necrosis. The serial changes of uterine echogenicity reflected the intracavity sloughing tissue, and cystourethroscopy revealed a focal bladder necrosis. Administration of appropriate antibiotics and timely expulsion of the focal pyoadenomyosis vaginally resulted in successful preservation of the uterus and spontaneous recovery of focal bladder necrosis without surgical intervention. A review of the relevant literature was conducted to explore the mechanisms of bladder necrosis after UAE, summarize post-embolization intervention and the outcome of vaginally expelled myoma, and to discuss the value of UAE for adenomyosis.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Li-Ying
authors.initials: LY
authors.lastname: Huang
authors.forename: Yu-Fan
authors.initials: YF
authors.lastname: Cheng
authors.forename: Chao-Cheng
authors.initials: CC
authors.lastname: Huang
authors.forename: Shiuh-Young
authors.initials: SY
authors.lastname: Chang
authors.forename: Fu-Tsai
authors.initials: FT
authors.lastname: Kung
mesh_terms: D000328:Adult; D001158:Arteries; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D004715:Endometriosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D004927:Escherichia coli Infections / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D009336:Necrosis; D013492:Suppuration; D014463:Ultrasonography; D001745:Urinary Bladder Diseases / Q000209:etiology* / Q000473:pathology; D014591:Uterine Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D014599:Uterus / Q000098:blood supply*; D014621:Vagina