Abstract
Late uterine hemorrhage caused by uterine artery pseudoaneurysm is a rare but life-threatening complication after uterine surgery. The association of uterine pseudoanerysm rupture causing rectal fistula has not been reported in literature as well as its management. Herein we report a case of massive late uterine bleeding and rectal bleeding after laparoscopic myomectomy. A 43 year old Caucasian nulliparous woman underwent laparoscopic excision of 8 cm posterior intramural myoma. One month later she developed acute abdominal pain and proctorrhagia. A Computer Tomography scan (CT) demonstrated a 10 cm pelvic hematoma. The transvaginal ultrasound (TVU) showed 1 cm aneurism of the uterine artery. Transarterial angiography confirmed the ruptured uterine artery pseudoaneurysm that was successfully embolized. Repeated colonoscopy showed a rectal fistula. Total parenteral nutrition (TPN) and antibiotic prophylaxis were started. During the following month the intensity and frequency of proctorrhagia gradually declined. After four week of TPN colonoscopy confirmed a complete fistula healing. Oral feeding was gradually reintroduced. Two months later an ultrasound scan showed a complete resolution of the pelvic hematoma. To the best of our knowledge this the first described association of two rare complications: a pseudoaneurysm rupture and the subsequent rectal laceration successfully treated with embolization and conservative management.
Highlights
Pseudoaneurysm of uterine artery (UAP) is a rare complication after gynecological, obstetric and pelvic surgery
Diagnosis can be made with Ultrasonography (US), Color Doppler Ultrasonography (CDUS), Computer Tomography (CT), Magnetic Resonance Imaging (MRI) and angiography
We report a case of pseudoaneurysm rupture associated with bleeding from the rectum and conservative management along with a review of literature
Summary
Pseudoaneurysm of uterine artery (UAP) is a rare complication after gynecological, obstetric and pelvic surgery. The incidence of pseudoaneurysm formation is not well known because it can be silent, the delay of symptoms if rupture occurs [1] and the diagnosis is not easy. A PubMed search of English literature was performed using: “uterine artery pseudoaneurysm” and “uterine artery pseudoaneurysm and rectal bleeding” .We found 106 articles, 105 for the first search and only one for the second. The latter refers to a case of locally advanced cervical [3]. Signs and Interval indications surgery, symptoms caused between yrs by uterine artery surgery pseudoaneurysm and symptom onset
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