Uterine necrosis and lumbosacral-plexopathy following pelvic vessel embolization for postpartum haemorrhage: report of two cases and review of literature

We are reporting two cases of uterine necrosis and lumbosacral-plexopathy in patients, who underwent pelvic vessel embolization (PVE) following postpartum hemorrhage. Embolization was performed with gelfoam slurry, polyvinyl alcohol (PVA) particles and coil in one patient and with gelfoam slurry only, in second patient. Both patients had lower limbs weakness and had persistent fever in the postembolization period. Nerve conduction study in both were suggestive of common peroneal and tibial neuropathy. An ultrasonography and computed tomography of abdomen and pelvis revealed bulky uterus with no identifiable endometrium and multiple air foci in subendometrial region suggestive of uterine necrosis, confirmed later by histology of expelled uterine mass. Lumbosacral ischemia resulting in paraparesis and uterine necrosis presenting as longstanding fever after embolization are extremely rare but overwhelming complications of embolization. Only 19 cases of uterine necrosis and <10 cases of lumbosacral plexopathy have been reported in the literature. The overall effectiveness of PVE is high in treatment of obstetric hemorrhage with low complication rate and highly selective PVE may further prevent these complication. To the best of our knowledge the co-existing uterine necrosis and lumbosacral plexopathy secondry to PVE has not been described prevoiusly in patients with postpartum hemorrhage. Both patients recovered with conservative management.