Uterine Artery Pseudoaneurysm after Cervical Cerclage: A Rare Case and Its Management Through Uterine Artery Embolization.

Abstract

Uterine arterial pseudoaneurysm (UAP) is a rare cause of vaginal bleeding. Usually, UAP follows cesarean section, uterine curettage, vaginal delivery, or cervical conization and must be considered in the differential diagnosis. Here we report a very unusual case of UAP causing intra-abdominal and vaginal bleeding after cervical cerclage and its successful management through the endovascular route. This 30-year-old P2L1A2 woman presented with vaginal bleeding after 7days following hysterotomy for termination of pregnancy. At 16weeks of her index pregnancy, she underwent cervical cerclage for cervical insufficiency, followed by an emergency hysterotomy at 20weeks for profuse vaginal bleeding after failed medical management. On ultrasound and contrast-enhanced computed tomography (CECT), uterine dehiscence and a cervical pseudoaneurysm were detected. Dehiscence was repaired surgically, and pseudoaneurysm was successfully managed by uterine artery embolization. UAP is an uncommon cause of vaginal bleeding; however, it should be considered in the differential diagnosis of a woman with unusual vaginal bleeding, particularly in the postpartum or postoperative setting like cesarean section, uterine curettage, cervical conization, or cerclage. Endovascular uterine artery embolization is a minimally invasive, effective, preferred, and safe method for managing UAP.