Misinterpretation of Postembolization Syndrome after Conservative Treatment of Fibroids

Uteroenteric fistula resulting from fibroid expulsion after uterine fibroid embolization: case report and review of the literature

A 44-year-old woman underwent uncomplicated uterine fibroid embolization (UFE) for menstrual and bulk-related symptoms in an enlarged, myomatous uterus. After surgery, she spontaneously sloughed a large mass of fibroids that arrested in the cervical canal during passage. Four days after gynecological extraction, she developed copious vaginal discharge that contained enteric contents. Contrast-enhanced computed tomography (CT) demonstrated a fistula between the small bowel and the uterus. She subsequently underwent hysterectomy, left oophorectomy, and small-bowel resection. Her postoperative recovery was uneventful.

Uterine Artery Embolization in the Management of Symptomatic Uterine Fibroids: An Overview of Complications and Follow-up

Uterine artery embolization (UAE) evolved as a treatment for symptomatic uterine fibroids in the early 1990s, after initially being used as a temporizing measure prior to hysterectomy or myomectomy. Since that time, over 100,000 UAEs have been performed. Technical success rates have been quoted ranging from 94 to 99%. The overall incidence of major complications associated with the procedure is low, the majority of which can be prevented. Knowledge of the potential complications and the measures that can be taken to avoid these complications is essential. Furthermore, because UAE is a relatively new procedure, no standardized recommendations for patient follow-up exist. Common practice for patient follow-up includes both clinic visits at increasing time intervals postprocedure, as well as telephone follow-up, and imaging follow-up when necessary. As symptomatic improvement is subjective, some institutions have developed standardized questionnaires to better assess patient improvement postprocedure. Aggressive pain control is a crucial component of follow-up, as uncontrolled pain can result in readmission and patient dissatisfaction.

Postembolization syndrome: changes in white blood cell counts immediately after uterine artery embolization

Postembolization syndrome (PES) after transcatheter uterine artery embolization (UAE) is classically described as including self-limited pain, nausea, vomiting, and fever. However, the expected components of PES after UAE might also include leukocytosis, the incidence and magnitude of which have not yet been determined. A retrospective review of 78 patients who underwent elective UAE for symptomatic leiomyomas showed an increase in white blood cell (WBC) counts within 24 hours after the procedure in 86% of patients, with clinically defined leukocytosis (WBC count >11,000/microL) present in 21% of patients. Interventional radiologists and other clinicians involved in the care of these patients should expect such changes and not be alarmed regarding early infectious complications.