Delayed Hemorrhage: A Rare Complication of Loop Electrosurgical Excision Procedure

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.