Sepsis Leading to Emergent Hysterectomy After Uterine Artery Embolization.

Background: Uterine artery embolization (UAE) is a minimally invasive radiologic procedure in which microspheres of polyvinyl alcohol particles are injected into the uterine artery to occlude blood flow. This paper reports a case of life-threatening sepsis requiring emergent hysterectomy following the therapeutic use of UAE to treat uterine hemorrhage. Case: This is a 42-year-old patient who had been referred to our center for uterine hemorrhage and was treated with UAE. The patient subsequently developed pyometria, leading to a lifethreatening gram-negative septicemia. She ultimately required an emergent surgery. Conclusion: This case demonstrates that uterine infection and sepsis may develop following uterine artery embolization for leiomyomata uteri. Early identification and treatment with intensive care unit (ICU) management, antibiotics, and, possibly, surgical intervention are important components in the management of sepsis following UAE. (J GYNECOL SURG 21:173

Pulmonary embolism after major abdominal surgery in gynecologic oncology.

OBJECTIVE: To estimate the incidence and prognostic significance of postoperative pulmonary embolism after gynecologic oncology surgery. METHODS: All patients who underwent gynecologic oncology surgery from June 2001 to June 2003 and received venous thromboembolism prophylaxis with only intermittent pneumatic compression and early ambulation were identified from our database. Patients were grouped by procedure (major/minor abdominal or nonabdominal surgery), diagnosis (malignant/nonmalignant), and cancer subtype. Groups were compared by chi2 analysis and logistic regression. Survival was studied with the Kaplan-Meier method and Mantel-Byar test. RESULTS: A total of 1,373 surgical patients were identified over the 2-year period, including 839 major abdominal surgery cases and 534 minor abdominal surgery or nonabdominal surgery cases. Of the 839 patients, 507 had a diagnosis of cancer, and 332 were benign. The incidence of pulmonary embolism among cancer patients undergoing major abdominal surgery was 4.1% (21/507) compared with 0.3% (1/332) among patients undergoing major abdominal surgery with benign findings (P \u3c .001, odds ratio [OR] 13.8, 95% confidence interval [CI] 1.9-102.1). The incidence of pulmonary embolism among patients undergoing minor/nonabdominal surgery was 0.4% (2/536). Cancer diagnosis and age more than 60 years were identified as risk factors for pulmonary embolism (P = .009, OR 0.31, 95% CI 0.13-0.74). One-year survival for patients with and those without pulmonary embolism were 48.0% +/- 12% and 77.0% +/- 2%, respectively. CONCLUSION: Patients with cancer undergoing major abdominal surgery and using pneumatic compression for thromboembolic prophylaxis had a 14-fold greater odds of developing a pulmonary embolism compared with patients with benign disease. Randomized studies are needed to determine whether additional prophylactic measures may benefit this high-risk group of patients. LEVEL OF EVIDENCE: II-3