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Intracavitary ethanol ablation for the management of uterine hemorrhage refractory to uterine artery embolization

      Highlights

      • Refractory uterine hemorrhage was treated by intracavitary ethanol injection.
      • Uterine bleeding was not controlled by two coil-based embolizations.
      • Intratumoral ethanol injection has proven effective, intracavitary seems feasible.

      Abstract

      A 57-year-old postmenopausal woman with end-stage liver disease secondary to alcoholic cirrhosis, esophageal varices, severe alcoholic cardiomyopathy, and metrorrhagia causing persistent anemia despite multiple transfusions presented with heavy vaginal bleeding. The patient underwent two uterine artery embolizations with proximal coils instead of directed particles due to difficult anatomy but the bleeding continued despite these interventions. Since she was a poor surgical candidate for hysterectomy, the decision was made to attempt achievement of hemostasis via ethanol injection into the uterine cavity. The patient's bleeding ceased, her hemoglobin and hematocrit stabilized post-procedure, and she was discharged home in stable condition.

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      References

        • Cramer S.F.
        • Patel A.
        The frequency of uterine leiomyomas.
        Am J Clin Pathol. 1990; 94: 435-438
        • Bulman J.C.
        • Ascher S.M.
        • Spies J.B.
        Current concepts in uterine fibroid embolization.
        Radiographics. 2012; 32: 1735-1750
        • Goodwin S.C.
        • Spies J.B.
        • Worthington-Kirsch R.
        • Peterson E.
        • Pron G.
        • Li S.
        • et al.
        Uterine artery embolization for treatment of leiomyomata: long-term outcomes from the FIBROID registry.
        Obstet Gynecol. 2008; 111: 22-33
        • Pessoa L.A.
        • Gurgel F.
        • Avila M.
        • Maior Mda C.S.
        • VMB Silva
        Midterm outcome of ultrasound-guided alcohol gel sclerotherapy for symptomatic leiomyoma.
        J Ultrasound Med. 2010; 29: 1323-1330
        • Hinchcliff E.M.
        • Cohen S.L.
        Laparoscopic hysterectomy for uterine fibroids: is it safe?.
        Clin Obstet Gynecol. 2016; 59: 66-72
        • Perkins R.B.
        • Handal-Orefice R.
        • Hanchate A.D.
        • Lin M.
        • Paasche-Orlow M.K.
        Risk of undetected cancer at the time of laparoscopic supracervical hysterectomy and laparoscopic myomectomy: implications for the use of power morcellation.
        Womens Health Issues. 2016; 26: 21-26
        • Lu B.
        • Xu J.
        • Pan Z.
        Iatrogenic parasitic leiomyoma and leiomyomatosis peritonealis disseminata following uterine morcellation.
        J Obstet Gynaecol Res. 2016; ([Epub ahead of print])
        • Parker W.
        • Berek J.S.
        • Pritts E.
        • Olive D.
        • Kaunitz A.M.
        • Chalas E.
        • et al.
        An open letter to the Food and Drug Administration regarding the use of morcellation procedures in women having surgery for presumed uterine myomas.
        J Minim Invasive Gynecol. 2016; 23: 303-308
        • Schirf B.E.
        • Vogelzang R.L.
        • Chrisman H.B.
        Complications of uterine fibroid embolization.
        Semin Interv Radiol. 2006; 23: 143-149
        • McLucas B.
        • Yaghmai B.
        • Beller M.
        Computed tomography angiogram for failed uterine artery embolization.
        Minim Invasive Ther Allied Technol. 2009; 18: 87-92
        • Yang Z.
        • Zhang Y.
        • Zhang R.
        • Zhang H.
        • Ma J.
        • Chen J.
        • et al.
        A case-control study of high-intensity focused ultrasound combined with sonographically guided intratumoral ethanol injection in the treatment of uterine fibroids.
        J Ultrasound Med. 2014; 33: 657-665
        • Isern J.
        • Pessarrodona A.
        • Rodriguez J.
        • Vallejo E.
        • Gimenez N.
        • Cassadó J.
        • et al.
        Using microbubble sonographic contrast agent to enhance the effect of high intensity focused ultrasound for the treatment of uterine fibroids.
        Ultrason Sonochem. 2015; 27: 688-693
        • Furman B.
        • Appelman Z.
        • Hagay Z.
        • Caspi B.
        Alcohol sclerotherapy for successful treatment of focal adenomyosis: a case report.
        Ultrasound Obstet Gynecol. 2007; 29: 460-462