Lumbosacral neuropathy and buttock necrosis after internal iliac arterial embolization in abundant bleeding cervical carcinoma

Objective: In advanced cases of cervical carcinoma, the tumor may cause massive bleeding requiring blood transfusion. When conservative management is ineffective, internal iliac arterial embolization (IIAE) may be life-saving. Case Report: The case of lumbosacral neuropathy and buttock necrosis that developed after IIAE. The posterior branch of the internal iliac artery gives the superior gluteal artery, ilio-lumbar artery, and lateral sacral artery. It was anticipated that the gluteal necrosis and neuropathy in this case developed due to ischemic damage with the occlusion of the posterior branch of the internal iliac artery by the embolizing agent. The use of selective embolization where nutrition of the posterior branch of internal iliac artery is preserved, will prevent similar complications.

Cervical cancer; Buttock necrosis; Neuropathy; Internal iliac artery embolization

[1] Salazar G.M., Petrozza J.C., Walker T.G.: “Transcatheter endovascular techniques for management of obstetrical and gynecologic emergencies”. Tech. Vasc. Interv. Radiol., 2009, 12, 139.

[2] Sobiczewski P., Bidziński M., Derlatka P.: “Laparoscopic ligature of the hypogastric artery in the case of bleeding in advanced cervical cancer”. Gynecol. Oncol., 2002, 84, 344.

[3] Miller F.J. Jr., Mortel R., Mann W.J., Jahshan A.E.: “Selective arterial embolization for control of hemorrhage in pelvic malignancy: femoral and brachial catheter approaches”. AJR Am. J. Roentgenol., 1976, 126, 1028

[4] Pisco J.M., Martins J.M., Correia M.G.: “Internal iliac artery: embolization to control hemorrhage from pelvic neoplasm”. Radiology, 1989, 172, 337.

[5] Mihmanli I., Cantasdemir M., Kantarci F., Halit Yılmaz M., Numan F., Mihmanlı V.: “Percutaneous embolization in the management of intractable vaginal bleeding”. Arch. Gynecol. Obstet., 2001, 264, 211.

[6] Yalvac S., Kayikcioglu F., Boran N., Tulunay G., Kose M.F., Bilgic S., Haberal A.: “Embolization of uterine artery in terminal stage cervical cancer”. Cancer Invest., 2002, 20, 754.

[7] Tinelli A., Prudenzano R., Malvasi A., Santantonio M., Lorusso V.: “Emergency endovascular nanopharmacologic treatment in advanced gynecological cancers”. Int. J. Gynecol. Cancer, 2010, 20, 1250.

[8] Hare W.S., Holland C.J.: “Paresis following internal iliac artery embolization”. Radiology, 1983, 146, 47.

[9] Kritpracha B., Comerota A.J.: “Unilateral lower extremity paralysis after coil embolization of an internal iliac artery aneurysm”. J. Vasc. Surg., 2004, 40, 819.

[10] Teare J., Evans E., Belli A., Wendler R.: “Sciatic nerve ischaemia after iliac artery occlusion balloon catheter placement for placenta percreta”. Int. J. Obstet. Anesth., 2014, 23, 178.

[11] Dietz D.M., Stahlfeld K.R., Bansal S.K., Christopherson W.A.: “Buttock necrosis after uterine artery embolization”. Obstet. Gynecol., 2004, 104, 1159.

[12] Smith D.D., Perez-Delboy A., Burke W.M., Tergas A.I.: “Buttock Necrosis after Uterine Artery Embolization for Delayed Hy sterectomy in Placenta Percreta”. Case Rep. Obstet. Gynecol., 2016, 2016, 6921280.

[13] Suzuki T., Kataoka Y., Minehara H., Nakamura K., Uchino M., Kawai K., Soma K.: “Transcatheter arterial embolization for pelvic fractures may potentially cause a triad of sequel: gluteal necrosis, rectal necrosis, and lower limb paresis”. J. Trauma, 2008, 65, 1547.

[14] Al-Thunyan A., Al-Meshal O., Al-Hussainan H., Al-Qahtani M.H., El-Sayed A.A., Al-Qattan M.M.: “Buttock necrosis and paraplegia after bilateral internal iliac artery embolization for postpartumhemorrhage”. Obstet. Gynecol., 2012, 120, 468.

[15] Terek M.C., Saylam C., Orhan M., Yilmaz A., Oztekin K.: “Surgical anatomy of the posterior division of the internal iliac artery: the important point for internal iliac artery ligation to control pelvic haemorrhage”. Aust. N. z. J. Obstet. Gynaecol., 2004, 44, 374.