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 that had migrated through the uterine wall induced formation of a uterine fistula. 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 patient presented migration of the fibroid through the uterine wall. Hysteroscopic 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 bleeding, and patients should be counseled to avoid pregnancy until the lesion heals completely.