Fibroid expulsion: a unique presentation of mechanical small bowel obstruction 11 years after uterine artery embolization: a case report

Background

Uterine artery embolization in the treatment of uterine leiomyoma has been rarely associated with dislodgement and expulsion of infarcted uterine fibroids through the vagina, peritoneum, or bowel wall, predominantly occurring within 6 months of uterine artery embolization.

Case presentation

We present the case of a 54-year-old African American woman who underwent uterine artery embolization 11 years prior and developed mechanical small bowel obstruction from the migration of fibroid through a uteroenteric fistula with ultimate impaction within the distal small bowel lumen. Small bowel resection and hysterectomy were curative.

Conclusions

Uteroenteric fistula with small bowel obstruction due to fibroid expulsion may present as a delayed finding after uterine artery embolization and requires heightened awareness.

Combination of Laparoscopic Salpingectomy and Endometrial Ablation: A Potentially Underused Procedure

Despite the advantages of a decreased risk of epithelial-cell ovarian cancer and the extremely minimally invasive nature of the procedure, combined salpingectomy and endometrial ablation is a potentially underused procedure in the United States to treat abnormal uterine bleeding and desired sterilization. The lack of utilization of this combined procedure might be based on factors other than clinical considerations, including slow acceptance and adoption of Committee Opinions expressing the value of salpingectomy over sterilization. Committee Opinions and randomized clinical trials have demonstrated the benefit of salpingectomy for sterilization and epithelial-cancer risk reduction, and there could be an additional protection against postablation tubal sterilization syndrome. This Commentary discusses the advantages and rationale for consideration of expanding usage of the combined approach.