# Delayed Hemorrhage: A Rare Complication of Loop Electrosurgical Excision Procedure

## TL;DR

A rare complication of a common cervical procedure can cause severe bleeding days later, especially in patients on certain medications.

## Contribution

The paper highlights the risk of delayed hemorrhage after LEEP and emphasizes the importance of patient education and preoperative risk assessment.

## Key findings

- Delayed hemorrhage occurred in a patient nine days after LEEP, requiring emergency surgery and transfusion.
- Clopidogrel use likely contributed to the severity of the hemorrhage.
- Preoperative risk identification and patient education are critical to prevent complications.

## Abstract

Loop electrosurgical excision procedure (LEEP) is a common procedure used to treat cervical dysplasia. It is performed by using an electrical current and loop wire to remove abnormal cervical tissue. Common complications include intraoperative and postoperative bleeding. A rare complication is delayed hemorrhage, presenting in 0.8-1.3% of women, which can require sutures, transfusions, or inpatient care. We present the case of a 41-year-old female presenting to the emergency department nine days after a LEEP procedure with heavy vaginal bleeding that resulted in delayed hemorrhage. Within hours of arrival, the patient passed several large clots and her hemoglobin dropped from 12.2 gm/mL to 6.9 gm/mL requiring emergency surgery and blood transfusion. The delayed hemorrhage was further exacerbated by this patient’s concurrent clopidogrel use. It is pivotal to identify high-risk patients to help prevent potential procedural complications through the use of preoperative instructions and emerging intraoperative interventions. It is also imperative to provide adequate guidance to patients about the postoperative course and how to identify signs and symptoms of a life-threatening situation.