Shadae Beale

Necrotising soft tissue infection following myomectomy: a devastating postoperative complication

This report describes a multiparous woman in her mid-40s who underwent an abdominal myomectomy for abnormal uterine bleeding due to fibroids and desire for fertility preservation which resulted in the rare consequence of uterine loss due to severe infectious complications postoperatively. Despite receiving prophylactic clindamycin at the index surgery, her postoperative course was complicated by an abdominal wall abscess as well as necrotising soft tissue infection involving the uterus. Management included parenteral antibiotics and a supracervical hysterectomy with bilateral salpingo-oophorectomy. There is a dearth of guidance regarding surgical site infection for myomectomy of any route. Limited data support a need for further high-quality clinical trials to develop decisive guidance regarding antibiotic prophylaxis at the time of myomectomy. As demonstrated in this case, the consequences have the potential to lead to infertility, menopause and even death.