Dying uterus, uterine artery ligation-a curse or a blessing? a rare case report

Abstract

Uterine necrosis is a rare life-threatening condition reported in few case reports associated with uterine artery embolization for uterine fibroids or postpartum hemorrhage. We report a case of hemorrhagic uterine necrosis in a 22-year-old primipara day 4 post emergency caesarean section who presented with breathlessness, abdominal distension and severe anaemia. Patient underwent emergency exploratory laparotomy 2 hours after the caesarean section with intraoperative findings suggestive of rectus muscle hematoma, bilateral uterine artery ligation was done for atonic PPH. On clinical examination uterus was corresponding to 28-30 weeks gestation size with guarding and tenderness. Ultrasonography revealed bulky uterus. CT abdomen with pelvis with contrast was done with findings suggestive of hemorrhagic ischaemic myometrial necrosis. An emergency exploratory laparotomy was performed with intraoperative findings of uterus size of 30 weeks gestation with diffuse congestion, gangrene of bilateral tubes and ovaries. Obstetric hysterectomy with bilateral salpingo-oovarectomy was done. Patient was discharged on postoperative day 9. High index of clinical suspension, prompt CT imaging and exploratory laparotomy on time proved life-saving.