Abstract
BackgroundPseudoaneurysm of the uterine artery (UPA) is a rare cause of potentially life-threatening hemorrhage during pregnancy and puerperium. It is an uncommon condition that mainly occurs after traumatic injury to a vessel following pelvic surgical intervention, but also has been reported based on underlying endometriosis. There is an increased risk of developing UPA during pregnancy. Diagnosis includes clinical symptoms, with severe abdominal pain and is confirmed by sonographic or magnetic resonance imaging (MRI). Due to its potential risk of rupture, with a subsequent hypovolemic maternal shock and high fetal mortality, an interdisciplinary treatment should be considered expeditiously.Case presentationWe present the case of a 34-year old pregnant symptomatic patient, where a large UPA was detected at 26 weeks, based on deep infiltrating endometriosis (DIE). The UPA was successfully treated by selective arterial embolization. After embolization, the pain decreased but the woman still required intravenous analgesics during follow-up. At 37 weeks she developed a sepsis from the intravenous catheter which led to a cesarean section and delivery of a healthy boy. She was discharged 10 days postpartum.ConclusionsUPA should be considered in pregnant women with severe abdominal and pelvic pain, once other obstetrical factors have been excluded. DIE might be the underlying diagnosis. It is a rare but potentially life-threatening condition for mother and fetus.
Highlights
Pseudoaneurysm of the uterine artery (UPA) is a rare cause of potentially life-threatening hemorrhage during pregnancy and puerperium
We present the observation of a pregnant patient with a successfully treated symptomatic Uterine pseudoaneurysm (UPA) that occurred in the second trimester, on the basis of a deep infiltrating endometriosis (DIE) in the left uterine artery and cervix
The magnetic resonance imaging (MRI) showed an endometriosis node 3x2cm adjacent to the septum rectovaginale with expansion to the left ovary and in close proximity to the sigmoid without infiltration according to an Enzian score A2, B1, C1. (Fig. 3 a and b) The restructuring operation of the symptomatic DIE is planned for 4 months after her delivery
Summary
Uterine pseudoaneurysm (UPA) is a condition in which the arterial vessel wall has lost intraluminal continuity and blood accumulates between the two outer layers of the artery It can present with severe abdominal and pelvic pain, and sonographic imaging or magnet resonance imaging (MRI) can detect a pulsatile growing mass. Case presentation The 34-year old, first gravida, was admitted to our obstetrical department by ambulance at + 0 weeks of gestation (WG) with progressive severe pain over h in the left lower abdomen irradiating to the rectum and the vagina The previous day, she had an unremarkable clinical and sonographic examination and a normal laboratory investigation. Sixteen days after hospitalization (25 + 3 WG), a pseudoaneurysm of the left uterine artery (2.5 cm × 1.5 cm) was identified by ultrasound (Fig. 1 c and d) and confirmed by MRI. The MRI showed an endometriosis node 3x2cm adjacent to the septum rectovaginale with expansion to the left ovary and in close proximity to the sigmoid without infiltration according to an Enzian score A2, B1, C1. (Fig. 3 a and b) The restructuring operation of the symptomatic DIE is planned for 4 months after her delivery
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