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Ginecología y obstetricia de México
Print version ISSN 0300-9041
Abstract
ESPINOSA-GARCIA, Carlos Manuel et al. Cistorraphy dehiscence in patients with uterine arteries embolization due to placentary acretism: report of two cases. Ginecol. obstet. Méx. [online]. 2020, vol.88, n.5, pp.334-341. Epub Sep 20, 2021. ISSN 0300-9041. https://doi.org/10.24245/gom.v88i5.3704.
BACKGROUND:
The incidence of percretism is 5-7% with 78% of complications associated with surgical management. There are few reported cases of cystorraphy dehiscence after uterine arteries embolization.
CLINICAL CASES:
Case 1. A 34 years old patient with a pregnancy of 36 5/7 weeks and acretism; she was treated with uterine artery embolization plus subtotal hysterectomy with bladder injury repaired without complications. She was discharged, and in 2 weeks she consulted for vaginal urine loss and fever (acute pyelonephritis); cystorraphy dehiscence was diagnosed with support of tomography and retrograde cystography. Bilateral ureteral catheterization, laparotomy with trachelectomy plus resection of bladder necrotic edges and cystorraphy were performed. Case 2. A 30 years old patient with a pregnancy of 37 5/7 weeks and acretism; equal treatment of acretism was given with bladder injury repaired without complications. She was hospitalized in surveillance for obstetric haemorrhage and urinary infection with torpid evolution; she referred vaginal urine loss at 2 weeks, so cystoscopy, tomography and retrograde cystography were performed which diagnosed cystorraphy dehiscence. In surgery the bladder defect was located by cystoscopy and hysteroscopy and bilateral ureters were catheterized; subsequently, by laparoscopic approach necrotic bladder edges were resected and cystorraphy was performed. Both patients without complications and with successful postoperative evolution.
CONCLUSION:
Cystorraphy dehiscence in embolized patients is extremely rare; however, it should be considered as a possible complication. Diagnostic suspicion and timely management with resection of necrosis and new cystorraphy, achieve greater success.
Keywords : Uterine artery embolization; Hysterectomy; Bladder injury; Necrotic; Cystorraphy; Cystoscopy; Tomography.