Iliac Artery Lesion as a Severe Complication of Hysteroscopic Myomectomy Daniela Angerame Yela, MD, PhD, Patrícia Kajikawa, MD, Cassia Raquel Juliato, MD, PhD, Cristina Laguma Benetti-Pinto, MD, PhD Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas, Campinas, Sa˜o Paulo, Brazil (all authors). ABSTRACT Hysteroscopic myomectomy is the surgical procedure of choice for the treatment of submucous or intramural myomas that protrude into the uterine cavity in patients with abnormal bleeding and/or infertility. It is a minimally invasive procedure associated with a low complication rate. Complications of hysteroscopy include uterine perforation, intraoperative and postoperative uterine bleeding, water intoxication, gas embolism, and injuries of the bladder, ureters, and major blood vessels, in addition to late complications, such as infections and synechiae. This case report describes iliac artery injury during hysteroscopic myomectomy. A review of the literature shows that this complication has not been recorded. Key Words: Hysteroscopy, Myomectomy, Complications, Iliac artery injury INTRODUCTION Hysteroscopy is a procedure that is routinely performed in gynecologic practice because of its diverse indications, such as premenopausal or postmenopausal abnormal uterine bleeding, infertility, recurrent abortions, pain, and alterations on imaging examinations in asymptomatic women. It is a minimally invasive procedure associated with a low complication rate. If used only for diagnosis, the process is limited to the visualization with or without sampling of myometrial or cervical canal lesions. Compli- cation rates in diagnostic hysteroscopy are very low, at about 0.13%. 1 Hysteroscopy is also used for intrauterine surgery as lysis of adhesions, metroplasty, myomectomy, polypectomy, sterilization, and endometrial ablation. Sur- gical hysteroscopy carries a higher risk for complications, ranging from 0.95% to 3.5%, as recorded in the litera- ture. 1–3 Hysteroscopic myomectomy is the surgical procedure of choice for the treatment of submucous or intramural my- omas that protrude into the uterine cavity in patients with abnormal bleeding and/or infertility. 4 First performed by Neuwirth in 1976, hysteroscopic myomectomy has be- come essential in the treatment of submucous myomas, especially among young women who desire to maintain fertility. 5 Although considered a less invasive surgical pro- cedure, along with metroplasty, hysteroscopic myomec- tomy has the highest risk for complications, with a prev- alence rate of up to 10%. 6 Complications of hysteroscopy may be related to cervical dilatation, distention medium with gas embolism, or to water intoxication. Mechanical complications are also possible, such as uterine perforation and injuries caused by instruments (e.g., lesions of the bladder, ureters, and major blood vessels). Also reported have been uterine bleeding and late complications, such as infections and synechiae. This case report describes iliac artery injury during hys- teroscopic myomectomy. In a review of the literature, we determined that this complication has not previously been recorded. CASE REPORT The patient was a Caucasian, 18-year-old nulliparous woman, receiving outpatient follow-up care for heavy Citation Yela DA, Kajikawa P, Juliato CR, Benetti-Pinto CL. Iliac artery lesion as a severe complication of hysteroscopic myomectomy. CRSLS e2014.00333. DOI: 10.4293/CRSLS.2014.00333. Copyright © 2014 SLS This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-ShareAlike 3.0 Unported license, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and source are credited. Address correspondence to: Daniela Angerame Yela, Departamento de Tocoginecologia, Faculdade de Cieˆncias Me´dicas, Universidade Estadual de Campinas – UNICAMP, Rua Alexander Fleming n°101, CEP:13083-970, Campinas, SP, Brazil; Telephone/fax: 55-19-3521-9306, E-mail: yela@unicamp.br. 1 e2014.00333 CRSLS MIS Case Reports from SLS.org CASE REPORT