Colonic ischemia possibly due to resuscitative endovascular balloon occlusion of the aorta (REBOA) used to manage amniotic fluid embolism: a case report

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) can control massive postpartum hemorrhage. CASE PRESENTATION: A 41-year-old woman transferred to hospital following cesarean section presented in refractory hemorrhagic shock. REBOA was blindly performed in the emergency department. She immediately underwent hysterectomy and damage control surgery in the operating room. The aortic balloon, whose position was confirmed at zone II by postoperative X-ray, provided intermittent occlusion for 40 min during surgery. Hemodynamics were stabilized with these interventions, with massive transfusion required for severe coagulopathy perioperatively. She gradually recovered with intensive care but suffered ascending colon ischemia with perforation on day 16. She received a colostomy and was discharged without sequelae after 130 days. Amniotic fluid embolism was diagnosed according to clinical criteria and supplemental serum markers. CONCLUSIONS: This patient suffered colonic ischemia possibly due to REBOA used to manage amniotic fluid embolism. REBOA requires careful consideration to avoid complications.