Ligation of the internal iliac (hypogastric) arteries has been used to control serious obstetric and pelvic bleeding. It is generally well tolerated in the young obstetric or gynaecological patient, presumably because of an extensive collateral blood supply.1-3 Acute lumbosacral plexopathies have been described, however, in older patients with vascular disease when the internal iliac arteries are interrupted.4-8 We report on a teenage patient with similar peripheral nerve ischaemia after bilateral internal iliac artery ligation for postpartum haemorrhage.

An 18 year old woman presented at 40 weeks gestation with mildly raised blood pressures, trace proteinuria, oliguria, and generalised oedema. She was diagnosed with pre-eclampsia and admitted for induction. When induction was unsuccessful, she underwent a caesarean section, which was complicated by uterine atony and a postpartum haemorrhage with an estimated blood loss of 2500 ml. After bilateral uterine artery ligation failed to control the bleeding, bilateral internal iliac artery ligation was performed with resultant haemostasis.

On the first postoperative day, she complained of left buttock pain and difficulty moving her left leg. Superficial skin breakdown over the sacrum and buttocks was noted on the second postoperative day. She developed a fever and fundal tenderness on day 4. Helical CT of the abdomen and pelvis disclosed residual gas and fluid within the endometrial canal consistent with endometritis, which was treated with intravenous antibiotics. No retroperitoneal haematoma was present. Neurological evaluation on the fifth postoperative day was limited by pain but disclosed normal strength, sensation, and reflexes in the arms and the right leg. Strength in the left leg was 2 to 3/5 on hip flexion and knee extension and 3 to 4/5 on ankle plantarflexion, …