A uterine cavity–myoma communication after uterine artery embolization: Two case reports

Objective To report two cases of uterine cavity–myoma fistula as a medical complication after uterine artery embolization. Design Case report. Setting Women's Medical Center/Viscomi Institute, Sao Paulo, Brazil. Patient(s) Two patients presenting with symptomatic myomatous uterus: a 40-year-old woman with increased abdominal volume and hypermenorrhea, and a 42-year-old woman with pelvic pain and infertility. Intervention(s) Uterine artery embolization, hysteroscopic follow-up, and laparoscopic myomectomy. Main outcome measure(s) Hysteroscopic follow-up after uterine artery embolization. Result(s) The patients underwent uterine artery embolization. In the months that followed, a subsequent surgical hysteroscopic follow-up was performed to eliminate the necrotic material of the degenerated myomas. The two patients presented the same outcome 1 year after the uterine artery embolization had been performed: a communication between the uterine cavity and a degenerated myoma. Laparoscopic correction of the uterine wall defect was performed afterward. Conclusion(s) Because embolization is a growing option for the treatment of leiomyoma, it is important that potential complications be reported, especially if the patients want to become pregnant. The natural history of the fistula and its consequences are unknown, and physicians should be aware of these complications. Hysteroscopic follow-up was important in the diagnosis of the two cases.