# Vulvar Necrosis Following Uterine Artery Embolisation for Uterine Fibroid Treatment: A Case Report and Literature Review

## TL;DR

A rare case of vulvar necrosis after UAE treatment for uterine fibroids is reported, emphasizing the importance of early detection and multidisciplinary care.

## Contribution

This case report adds to the limited literature on vulvar necrosis as a rare UAE complication and highlights clinical management strategies.

## Key findings

- Vulvar necrosis following UAE is exceptionally rare but requires prompt multidisciplinary care.
- The patient achieved full vulvar healing after surgical debridement and conservative management of gluteal necrosis.
- Long-term follow-up showed resolution of gynecological symptoms but development of a possible piriformis-related leg pain.

## Abstract

Uterine artery embolisation (UAE) is a recognised minimally invasive treatment for symptomatic uterine fibroids, with a generally favourable safety profile. Although post-embolisation complications are well documented, vulvar necrosis is exceptionally rare.

We report the case of a 50-year-old woman of Black African heritage who developed severe vulvar symptoms eight days after UAE was undertaken for symptomatic multiple fibroids. She presented with intense vulvar pain, swelling, erythema, ulceration, and right-sided gluteal skin changes, alongside numbness in the lateral right leg.

Examination revealed ulceration and sloughing of the right vulva, with progression to gluteal necrosis over seven days. CT and MRI imaging demonstrated inflammatory changes and infarction of the subcutaneous fat in the right buttock, consistent with non-target embolisation. Multidisciplinary assessment concluded that the findings were due to extravasation of embolic material into the gluteal region.

The patient received broad-spectrum intravenous antibiotics, neuropathic pain management, and multidisciplinary care involving gynaecology, surgery, interventional radiology, pain management, neurology, and tissue viability teams. She underwent surgical debridement of the necrotic vulvar tissue, achieving full healing. The gluteal necrosis was managed conservatively with spontaneous resolution. At three-month follow-up, she was asymptomatic from a gynaecological perspective; at two years, she was diagnosed with right leg pain syndrome, possibly piriformis-related.

Vulvar necrosis following UAE is an exceptionally rare but clinically significant complication. This case highlights the need for early recognition of post-procedural vulvar or gluteal changes and rapid multidisciplinary intervention to optimise outcomes. Increased reporting of such cases may help clarify risk factors, refine preventive strategies, and guide management.