Uterine fistula induced by hysteroscopic resection of an embolized migrated fibroid: a rare complication after embolization of uterine fibroids

Objective: To describe a case in which hysteroscopic removal of a fibroid t hat had migrated through the uterine wall induced formation of a uterine fi stula. Design: after embolization of uterine fibroids, an investigative clinical, sonographic, and hysteroscopic protocol was followed. Setting: Gynecologic clinic of a university hospital. Patient(s): A 38-year-old woman undergoing embolization of uterine arteries for uterine fibroids. Intervention(s): Angiography-guided transcatheter bilateral embolization of uterine arteries, with clinical, sonographic and hysteroscopic follow-up. Main Outcome Measure(s): Patient morbidity and satisfactory intercourse. Result(s): Six months after embolization of the uterine arteries, the patie nt presented migration of the fibroid through the uterine wall. Hysteroscop ic removal of the fibroid induced posthysteroscopic formation of a uterine fistula. Conclusion(s): After embolization of the uterine arteries, thorough follow- up examination of the uterine cavity is strictly recommended. Diagnosis of a uterine wall perforation can identify an abnormal source of uterine bleed ing, and patients should be counseled to avoid pregnancy until the lesion h eals completely. (Fertil Steril (R) 2001;75:818-20. (C) 2001 by American So ciety for Reproductive Medicine.)