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Background <p>Uterine necrosis is a rare but potentially life-threatening complication of conservative surgical management for postpartum hemorrhage (PPH). Early diagnosis is challenging because the clinical presentation may mimic postpartum infection or endometritis.</p> Case Presentation <p>A 38-year-old multiparous woman underwent cesarean delivery complicated by severe atonic PPH. Following failure of medical management, bilateral uterine artery ligation and uterine compression sutures were performed to control hemorrhage. Two weeks later, she presented with severe abdominal pain, fever, abdominal distension, foul-smelling lochia, and septic shock. Ultrasonography demonstrated a markedly enlarged uterus with multiple hyperechoic intramyometrial foci suggestive of intramyometrial gas. Emergency laparotomy revealed extensive gangrenous necrosis of the uterine corpus with preservation of cervical viability. Based on intraoperative confirmation of an intact cervical blood supply, supracervical hysterectomy was performed. Histopathological examination confirmed extensive transmural ischemic uterine necrosis with acute inflammation. The patient recovered uneventfully following surgery and broad-spectrum antibiotic therapy.</p> Conclusion <p>Uterine necrosis should be considered in postpartum women presenting with sepsis and abdominal pain after uterine-sparing surgical procedures for PPH. Prompt recognition, appropriate imaging, and early surgical intervention are critical to reduce morbidity and mortality. Careful intraoperative assessment of cervical viability may permit supracervical hysterectomy in selected patients, preserving the cervix when its vascular supply remains intact.</p>

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Complete Uterine Corpus Necrosis with Preserved Cervical Viability Following Conservative Surgical Management of Postpartum Hemorrhage: A Case Report

  • 期刊论文

  • 发表日期：

    2026年8月4日

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  • Atef M. Darwish,
  • Dina A. Darwish

摘要

Background

Uterine necrosis is a rare but potentially life-threatening complication of conservative surgical management for postpartum hemorrhage (PPH). Early diagnosis is challenging because the clinical presentation may mimic postpartum infection or endometritis.

Case Presentation

A 38-year-old multiparous woman underwent cesarean delivery complicated by severe atonic PPH. Following failure of medical management, bilateral uterine artery ligation and uterine compression sutures were performed to control hemorrhage. Two weeks later, she presented with severe abdominal pain, fever, abdominal distension, foul-smelling lochia, and septic shock. Ultrasonography demonstrated a markedly enlarged uterus with multiple hyperechoic intramyometrial foci suggestive of intramyometrial gas. Emergency laparotomy revealed extensive gangrenous necrosis of the uterine corpus with preservation of cervical viability. Based on intraoperative confirmation of an intact cervical blood supply, supracervical hysterectomy was performed. Histopathological examination confirmed extensive transmural ischemic uterine necrosis with acute inflammation. The patient recovered uneventfully following surgery and broad-spectrum antibiotic therapy.

Conclusion

Uterine necrosis should be considered in postpartum women presenting with sepsis and abdominal pain after uterine-sparing surgical procedures for PPH. Prompt recognition, appropriate imaging, and early surgical intervention are critical to reduce morbidity and mortality. Careful intraoperative assessment of cervical viability may permit supracervical hysterectomy in selected patients, preserving the cervix when its vascular supply remains intact.