Two cases of myomectomy complicated by intravascular hemolysis and renal failure: disseminated intravascular coagulation or hemolytic uremic syndrome?
OBJECTIVE
To present two cases of myomectomy complicated by intravascular hemolysis leading to acute renal failure and discuss the differential diagnosis and possible mechanism.


METHODS
Case report.


METHODS
Minimally Invasive Therapy Unit, University Department of Obstetrics and Gynecology.


METHODS
Two premenopausal patients with uterine fibroids.


METHODS
Both patients underwent otherwise uncomplicated myomectomies, one by laparotomy and one by laparoscopy, with tourniquets around the uterine and ovarian vessels being used to control intraoperative bleeding.


METHODS
Renal function in the postoperative period.


RESULTS
Both patients developed a very rare complication after surgery of severe thrombocytopenia with microangiopathic hemolytic anemia leading to acute renal failure. One patient made a full recovery within weeks but the other still has reduced renal function almost 2 years after the surgery. The differential diagnosis consisted of disseminated intravascular coagulation or hemolytic uremic syndrome.


CONCLUSIONS
The etiology of thrombotic microangiopathy in these patients was unclear, but disruption and manipulation of fibroids during surgery may have led to the dissemination of pro-coagulant tissue factor containing particles leading to disseminated intravascular coagulation or hemolytic uremic syndrome, perhaps aggravated by utero-ovarian ischemia caused by the tourniquets.
Tsimpanakos
Ioannis
I
Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, Hampstead, London, United Kingdom.
Connolly
John
J
Alatzoglou
Kyriaki S
KS
Rowan
Camilla
C
Magos
Adam
A
D000328:Adult; D003937:Diagnosis, Differential; D004211:Disseminated Intravascular Coagulation / Q000150:complications* / Q000175:diagnosis; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006461:Hemolysis / Q000502:physiology; D006463:Hemolytic-Uremic Syndrome / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D051437:Renal Insufficiency / Q000150:complications* / Q000175:diagnosis; D014594:Uterine Neoplasms / Q000601:surgery*