title: Acute rectal ischaemia after bilateral uterine artery embolization and urgent hysterectomy to treat massive bleeding.
abstract: BACKGROUND
  This is the first case of total rectal and anal canal necrosis following uterine arteries embolization described in the literature.
  
  
  METHODS
  A 34 year-old woman suffered from massive Post Partum Haemorrhage. A vascular surgeon performed bilateral uterine arteries embolization with absorbable gelatin sponge which did not allowed a sufficient control of the bleeding, leading to hysterectomy. Perineal gangrene was diagnosed on day 10 on CT scan, pelvic MRI, and rectosigmoidoscopy. The etiology was a rectal ischaemia going from the level of the second sacral vertebra to the anal canal. Drainage and a lateral laparoscopic sigmoidostomy were associated to antibiotherapy.
  
  
  CONCLUSIONS
  Ornan et al. described complications of bilateral uterine arteries embolization in a serie of 28 patients with post partum haemorrhage. One of these patients presented a necrotic segment of small bowel 7 days after the embolization, she required a surgery. The hypothesis for these kinds of complications is the migration of the gelatine sponge particles.
  
  
  CONCLUSIONS
  This rare but life-threatening complication has never been reported before and should be known when considering perineal pain after bilateral uterine arteries embolization.
authors.affiliation: Service d'Urgences Chirurgicales, Chirurgie Digestive, 5 Place d'Arsonval, 69003 Lyon, France. Electronic address: annesodidnee@hotmail.fr.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Didnée
authors.affiliation: Service de Chirurgie Vasculaire, CHD Vendée, Boulevard Stéphane Moreau, 85000 La Roche sur Yon, France.
authors.forename: Poirier
authors.initials: P
authors.lastname: Philippei
authors.affiliation: Service de Chirurgie Digestive, CHD Vendée, Boulevard Stéphane Moreau, 85000 La Roche sur Yon, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Marc-Henri
authors.affiliation: Service d'Urgences Chirurgicales, Chirurgie Digestive, 5 Place d'Arsonval, 69003 Lyon, France.
authors.forename: Samuels
authors.initials: S
authors.lastname: Louisa
authors.affiliation: Service de Chirurgie Digestive, CHD Vendée, Boulevard Stéphane Moreau, 85000 La Roche sur Yon, France.
authors.forename: Comy
authors.initials: C
authors.lastname: Michel
keywords: Acute rectal ischemia; Uterine artery embolisation