Abstract

OBJECTIVE:

To present two cases of myomectomy complicated by intravascular hemolysis leading to acute renal failure and discuss the differential diagnosis and possible mechanism.

DESIGN:

Case report.

SETTING:

Minimally Invasive Therapy Unit, University Department of Obstetrics and Gynecology.

PATIENT(S):

Two premenopausal patients with uterine fibroids.

INTERVENTION(S):

Both patients underwent otherwise uncomplicated myomectomies, one by laparotomy and one by laparoscopy, with tourniquets around the uterine and ovarian vessels being used to control intraoperative bleeding.

MAIN OUTCOME MEASURE(S):

Renal function in the postoperative period.

RESULT(S):

Both patients developed a very rare complication after surgery of severe thrombocytopenia with microangiopathic hemolytic anemia leading to acute renal failure. One patient made a full recovery within weeks but the other still has reduced renal function almost 2 years after the surgery. The differential diagnosis consisted of disseminated intravascular coagulation or hemolytic uremic syndrome.

CONCLUSION(S):

The etiology of thrombotic microangiopathy in these patients was unclear, but disruption and manipulation of fibroids during surgery may have led to the dissemination of pro-coagulant tissue factor containing particles leading to disseminated intravascular coagulation or hemolytic uremic syndrome, perhaps aggravated by utero-ovarian ischemia caused by the tourniquets.

Copyright 2010 American Society for Reproductive Medicine. All rights reserved.