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Case Report
Perioperative hypersensitivity to a vaginal cuff hemostatic agent in the setting of alpha-gal syndrome
1 Resident, Department of Obstetrics and Gynecology, Oklahoma State University Medical Center, Tulsa, OK, USA
2 Gynecologist, Department of Obstetrics and Gynecology, Cherokee Nation W. W. Hastings Hospital, Tahlequah, OK, USA
3 Dean, Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA
4 Medical student, Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA
5 Clinical associate professor, Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA
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Bridget Botsford
717 S Houston Avenue #200, Tulsa, OK 74127,
USA
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Article ID: 100047G06BB2026
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Botsford B, Dorsett T, Bray N, Shed A, Jones A. Perioperative hypersensitivity to a vaginal cuff hemostatic agent in the setting of alpha-gal syndrome. Edorium J Gynecol Obstet 2026;10(2):15–23.ABSTRACT
Introduction: Alpha-gal syndrome (AGS) is an increasingly recognized immunoglobulin E (IgE)-mediated hypersensitivity disorder to mammalian-derived products that carries serious surgical implications if not considered perioperatively. As hemostatic agents are frequently utilized during gynecologic surgery, surgeons must be familiar with their components and potential adverse effects. Delayed hypersensitivity reactions (DHRs) to animal-derived surgical materials remain an underexplored area. Heightened surgeon awareness of appropriate hemostatic agent selection is critical, particularly in patients with AGS.
Case Report: We present the perioperative course of a 42-year-old woman with known AGS who underwent an elective hysterectomy for abnormal uterine bleeding and dysmenorrhea. Intraoperatively, a bovine-derived hemostatic agent was applied to the vaginal cuff. Her postoperative course was complicated by a delayed presentation of pelvic hematoma, abscess formation, vaginal cuff dehiscence, and necrosis, requiring three additional surgeries. Notably, this patient demonstrated persistent eosinophilia without leukocytosis despite pathologically confirmed pelvic abscesses—an atypical finding suggestive of an immune-mediated process rather than isolated infection.
Conclusion: The clinical course is consistent with a DHR superimposed on secondary infection following intraoperative exposure to a bovine-derived hemostatic agent in a patient with known AGS. This case highlights the potential severity, adverse outcomes, protracted hospital course, and resource utilization associated with inadvertent exposure to animal-derived surgical materials in patients with AGS. Delayed hypersensitivity reactions may not be immediately recognized, so surgeons should maintain heightened vigilance when operating on patients with known AGS and explore alternative hemostatic agents to prevent avoidable adverse outcomes.
Keywords: Alpha-gal syndrome, Delayed hypersensitivity, Gynecologic surgery, Hemostatic agents
SUPPORTING INFORMATION
Acknowledgments
Thank you, Dr. Sharon Smallwood, MD, for your assistance in gaining approval from Cherokee Nation Health Services to initiate this case report.
Author ContributionsBridget Botsford - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Tschantre Dorsett - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Natasha Bray - Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Allisyn Shed - Interpretation of data, Drafting the article, Final approval of the version to be published
Alexis Jones - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2026 Bridget Botsford et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
