Postpartum uterine necrosis with spontaneous endometrial prolapse after B‐Lynch suture: A case report

Postpartum uterine necrosis is a rare and serious complication. The uterine tissue becomes devascularized and then causes endometrial necrosis and even myometrial necrosis, usually combing with uterine infection. To clear the infection, hysterectomy was performed in the majority of uterine necrosis cases. We reported a case of a 26-year-old patient underwent a cesarean section after failure induction of labor with the full dilatation of cervix. The B-Lynch compression suture was performed to avoid persistent haemorrhage. The patient presented with recurrent fever, abdominal pain and vaginal discharge. The computed tomography scan revealed uterine empyema and uterine perforation of the anterior wall. The broad spectrum antibiotics were given to treat with infection. An irregularly shaped prolapse from the vagina was noted on the fifty-fourth day postpartum. Transvaginal debridement was performed and necrotizing tissues weighted about 100 g was removed. The pathological findings revealed degeneration and necrosis of the uterine muscle and fibrinoid exudation. Postpartum uterine necrosis is a rare condition that can lead to life-threatening complications and the most treatment option is the surgery of hysterectomy. As cases of partial uterine necrosis with symptom of endometrial prolapse, treated with direct appropriate antibiotic therapy, removing the necrotizing tissue that reserved the uterine may be a selective option.