Uterine pseudoaneurysm on the basis of deep infiltrating endometriosis during pregnancy-a case report

Postpartum hemoperitoneum - A rare case of uterine artery pseudoaneurysm rupture after uncomplicated vaginal delivery

OBJECTIVE

Our aim is to demonstrate a rare cause of hemoperitoneum without vaginal bleeding resulting from the rupture of a uterine artery pseudoaneurysm after uncomplicated vaginal delivery.

CASE REPORT

A 39-year-old woman who had experienced a normal vaginal delivery 8 days previously to being seen in our hospital, was presented to the emergency room with hypovolemic shock. Computed tomography angiography (CTA) showed massive internal bleeding and a ruptured pseudoaneurysm arising from the left uterine artery. The patient was successfully treated through transcatheter arterial embolization (TAE).

CONCLUSION

A pseudoaneurysm is a rare disease which can occur during an uncomplicated vaginal delivery. The clinical presentation can vary from asymptomatic, vaginal bleeding or hemoperitoneum. The diagnosis can be made by using Doppler sonography, CTA or Magnetic Resonance Imaging. The use of TAE is now the most common treatment option and possesses a high success rate.

Treatment of uterine artery (pseudo)aneurysm during pregnancy: A case report and review of the literature

PURPOSE

To describe the management of uterine artery (pseudo)aneurysm, ruptured or unruptured, during pregnancy.

METHODS

After reporting a case about this rare pathology, a review of the literature was performed. The search was applied to PubMed databases.

RESULTS

A total of eighteen articles met the inclusion criteria. Eighteen patients were reported. Eight (44.4 %) patients didn't have prior medical or surgical history. Fifteen (83.3 %) beneficed interventional radiology method during pregnancy including two cases (13.3 %) with repeated embolization because of recanalization of the (pseudo)aneurysm. Nine patients (50 %) beneficed a planned cesarean between 34 and 39 weeks of gestation. One (15.8 %) patient was diagnosed with fetal death before treatment of the uterine artery (pseudo)aneurysm.

CONCLUSION

The decision to proceed to the treatment of the (pseudo)aneurysm must consider several factors, associated or not with a good fetal vitality and a hemodynamically stable patient. Embolization appears to be the method of choice. Mode of delivery and term remain not clear and contraindication of expulsive efforts in case of a uterine artery (pseudo)aneurysm merit further investigations.

Transarterial embolization of acquired uterine artery pseudoaneurysm post cesarean section: A case report

We present a case report of 31 31-year-old woman with refractory secondary postpartum hemorrhage after 44 days of cesarian section. Patient was in shock and found to have a ruptured Uterine artery pseudoaneurysm (UAP) in computed tomography angiography (CTA). Emergency trans-arterial Uterine artery embolization (UAE) was performed, aiding in the stabilization and recovery of the patient. The benefits of early recovery, minimal invasiveness, and the option of preserving fertility are offered by UAE compared to uterine artery ligation or hysterectomy.

Endovascular coil-embolization of an unruptured, true UAA during early pregnancy- a case report

BACKGROUND

True uterine artery aneurysms, especially during pregnancy, are a rare entity and not well understood. Clinical symptoms are unspecific pelvic pain and pressure. Diagnosis can be confirmed by transvaginal color-coded-sonography and/or magnetic resonance imaging. Because of potential risk of rupture, immediate interdisciplinary discussion and treatment planning in the best interests of both mother and child is crucial.

CASE PRESENTATION

We present a 31-year-old pregnant woman with increasing pelvic pain and pressure. Diagnosis of an unruptured uterine artery aneurysm was confirmed by color-coded-sonography and magnetic resonance angiography. After interdisciplinary consultation, successful endovascular super-selective coil-embolization was performed by using X-ray fluoroscopy. Thus, fetal radiation dose during treatment with 4.33 mGy (VirtualDoseTM) was as low as possible with no immediate harm to the fetus.

CONCLUSIONS

Unruptured true uterine artery aneurysms can be successfully treated by endovascular super-selective coil-embolization during early pregnancy with no immediate harm to the fetus.

Embolization of uterine artery pseudoaneurysm during pregnancy: case report and review of the literature

Objectives

Uterine artery pseudoaneurysm (UAP) is a rare but sinister complication during pregnancy. Diagnosis can be made by color Doppler ultrasound. Previous abdominal- and obstetric surgery increase the risk for UAP formation.

Case presentation

We present a case of a 36 year young healthy women, presenting at 27 weeks of gestation with acute lower abdominal pain. UAP was detected by color Doppler ultrasound. An endovascular coil embolization was performed, with good maternal and fetal outcome. Furthermore, a review of the literature looking at UAP embolization in pregnancy was performed.

Conclusions

UAP is reported to appear as a complication of endometriosis. UAP should be treated by endovascular coil embolization, which is a safe and with almost 100% success rate an effective treatment during pregnancy.

Vaginal Hemorrhage Associated with Decidualized Rectovaginal Deep Infiltrating Endometriosis during the Third Trimester of Pregnancy: A Case Report

Endometriosis-related symptoms are believed to be alleviated during pregnancy. However, pregnancy complications, such as pseudoaneurysm of the uterine artery, rupture of ovarian or uterine vessels, and intraabdominal bleeding from decidualized deep infiltrating endometriosis (DIE) lesion have been rarely reported. Owing to the potential risk of rupture and resultant life-threatening complications, proper diagnosis and close monitoring of decidualized endometriotic lesion are very important despite its low relative risk. Till date, massive vaginal bleeding from decidualized rectovaginal DIE during pregnancy has not been in English literatures. Here, we present the first case of spontaneous massive vaginal bleeding due to decidualized rectovaginal DIE that occurred in the late third trimester of pregnancy.

Ultrasound Imaging of Acquired Myometrial Pseudoaneurysm: The Role of Manipulators as an Unusual Cause during Laparoscopic Surgery

An acquired uterine artery myometrial pseudoaneurysm can occur due to inflammation, trauma, or iatrogenic causes, such as surgical procedures, and can lead to profuse bleeding. The efficacy of uterine manipulators in gynecological surgery, particularly as a cause of a pseudoaneurysm, has been poorly discussed in the literature. In this paper, we discuss a case of a 39-year-old woman with profuse uterine bleeding that occurred seven days after operative laparoscopic surgery for endometriosis. The color Doppler ultrasound better evoked the arterial-like turbulent blood flow inside this cavity. These sonographic features were highly suggestive of uterine artery pseudoaneurysm, presumably related to a secondary trauma caused by the manipulator. The diagnosis was subsequently re-confirmed by angiography, and the patient was treated conservatively with uterine artery embolization. Ultrasound has been shown to be a valuable and safe tool for imaging pseudoaneurysm and guiding subsequent interventional procedures. Accordingly, we briefly review the most suitable manipulators used in benign gynecological surgeries to verify if the different types in use can guide the surgeon towards the correct choice according to surgical needs and thus prevent potentially dangerous trauma.

Imaging spectrum of acquired uterine vascular abnormalities with angiographic correlates, a pictorial review

Background

Acquired uterine arterial anomalies, including uterine artery pseudoaneurysms (UAP), arteriovenous malformations (AVMs) and arteriovenous fistulae (AFVs), are rare presenting causes of abnormal uterine bleeding. Timely diagnosis is essential for safe and effective treatment, avoiding life-threatening haemorrhage resulting from erroneous uterine curettage due to misdiagnosing these as other more common differentials.

Main text

This pictorial review discusses the ultrasound (USG), CT and MRI features of various acquired uterine vascular abnormalities with angiographic correlates.

Conclusion

Acquired uterine arteriovenous injuries are a fundamental cause of dysfunctional intractable bleeding recalcitrant to traditional conservative management. Endovascular transcatheter uterine artery embolisation is an increasingly popular and safe mode of treatment, especially in young patients desiring to have the option of future pregnancies, with lesser morbidity and in-hospital stay duration.