Ovarian Artery Aneurysm After Postpartum Hemorrhage

Abstract

INTRODUCTION: Ovarian artery aneurysm rupture can be a life-threatening event and although rare, with less than 25 cases present in the English literature, it is an important pathological process. As a result of the asymptomatic nature of most ovarian artery aneurysms, the condition is likely underdiagnosed and thus risk factors for rupture likely understudied. Various theories regarding ovarian artery aneurysm development exist. In addition to plausible perspectives relating to the physiologic changes of pregnancy, hypertension is also a well-recognized risk factor for aneurysm development in humans and that elevated blood pressure affects many pregnant and nonpregnant individuals today. METHODS: We present the case of a 25-year-old multiparous woman with gestational hypertension who presented on postpartum day 6 after a spontaneous vaginal delivery with abdominal pain localized to the right lower quadrant. This delivery was complicated by postpartum hemorrhage ultimately controlled with a bimanual massage and misoprostol. Computed tomography of her abdomen and pelvis revealed a large right retroperitoneal hematoma, which, on angiography, was discovered to have resulted from a ruptured ovarian artery aneurysm. CONCLUSION: We acknowledge the possibility of including hypertension as a risk factor for ovarian artery aneurysm development as well as vigorous uterine massage as a possible supporting historical finding in consideration of aneurysm rupture in this scenario. Given these considerations, maintaining a high index of suspicion for this condition in the postpartum patient given may lead to earlier diagnosis and life-saving treatment as well as to an improved understanding of ovarian artery aneurysm formation and rupture.