Uterine Artery Pseudoaneurysm Rupture Research Articles

Rotura de seudoaneurisma de la arteria uterina posterior a cesárea

La hemorragia posparto es una causa importante de mortalidad materna. La rotura del pseudoaneurisma de la arteria uterina es una lesión vascular con prevalencia desconocida que produce hemorragia posparto secundaria sin causa evidente. Puede ser potencialmente mortal, si no es diagnosticada y tratada adecuadamente. La etiología incluye traumatismo vascular durante la cesárea, parto vaginal, legrado o histerotomía. Su presentación clínica tiene variedad de síntomas que a menudo se asocian con otras patologías ginecológicas / obstétricas más frecuentes, con y sin sangrado vaginal, y puede abarcar desde ausencia de síntomas hasta hemorragia posparto severa con choque hipovolémico. Para evitar la hemorragia mortal, se debe hacer un diagnóstico rápido y preciso que muestre la naturaleza vascular de esta lesión. El diagnóstico está basado en estudios de imágenes no invasivos. En casos seleccionados adecuadamente, la embolización angiográfica es un método seguro y eficaz para controlar la hemorragia en pacientes hemodinámicamente estables y debe ser una opción antes de recurrir a la cirugía. Se describe un caso de rotura de pseudoaneurisma de arteria uterina posterior a cesárea.

Spontaneous Uterine Artery Pseudoaneurysm Rupture Following Cesarean Section: A Case Report

A pseudoaneurysm, also known as false aneurysm, is a collection of blood in perivascular soft tissue. Iatrogenic cause such as arterial catheterization and abdominopelvic surgery is one of the most common etiologies of pseudoaneurysm formation. Pseudoaneurysm in pelvic vessels is a complication of pelvic surgery or vessel catheterization. Cesarean section is the most common reported cause. In this article we introduced a 25 years old woman presented with abdominal pain and vaginal bleeding 1 week after Cesarean section. Imaging modalities confirmed the diagnosis of left uterine artery pseudoanurysm. Patient was admitted to treat by endovascular intervention. Several hours after admission blood pressure decreased and abdominal pain became more sever, ultra sound study showed evidence of free fluid in abdominopelvic cavity suggestive of pseudoaneurysm rupture. Emergence laparotomy surgery and hysterectomy were done due to active bleeding secondary to pseudoaneurysm rupture. Patient was discharged from hospital 5 days after surgery without any new complication.

Conservative Management of Uterine Artery Pseudoaneurysm Rupture with Rectal Fistula after Laparoscopic Myomectomy and Review of the Literature

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.

Rupture of uterine artery pseudoaneurysm after cesarean section; a case report

Rupture of uterine artery pseudoaneurysm after cesarean section; a case report

Postpartum hemorrhage caused by uterine artery pseudoaneurysm and uterine rupture after vaginal delivery

A case of massive hemoperitoneum determined by uterine rupture and uterine artery pseudoaneurysm dissection after vaginal delivery, requiring an emergency laparotomy with arterial ligation, is reported. The authors reviewed the published literature, finding 12 cases of uterine artery pseudoaneurysm and associated postpartum hemorrhage after vaginal delivery, but no cases with uterine rupture have ever been published. Diagnosis is based upon imaging, and management options include arterial embolization, arterial ligation and hysterectomy in particularly severe and life-threatening situations. Vaginal bleeding is associated with favorable outcomes and conservative treatment, while the absence of external blood loss seems to be correlated with a worsened prognosis and the need for an invasive treatment option. Uterine artery pseudoaneurysm rupture after vaginal delivery is a very rare condition of life-threatening postpartum hemorrhage, being more frequently associated with cesarean section. Uterine artery pseudoaneurysm dissection should be suspected in any patient presenting with early or delayed postpartum hemorrhage after a vaginal delivery and can be associated with uterine rupture.

Secondary postpartum hemorrhage due to uterine artery pseudoaneurysm rupture in von Willebrand disease

We here report a case of a 33-year-old woman who experienced secondary postpartum hemorrhage (PPH) due to uterine artery pseudoaneurysm rupture. She had intrauterine balloon tamponade for unexplained primary PPH after spontaneous vaginal delivery, and subsequent angiography showed no abnormal contrast extravasation. However, profuse vaginal bleeding occurred 22 days postpartum. Color Doppler ultrasonography demonstrated an anechoic mass with turbulent flow in the lower uterine segment, corresponding to uterine artery pseudoaneurysm. She was successfully treated with selective uterine arterial embolization. Decreased levels of von Willebrand factor and factor VIII led to the diagnosis of von Willebrand disease. When it is determined that a patient has unexplained PPH or uterine artery pseudoaneurysm, a high index of suspicion and further investigation for underlying bleeding disorders is warranted.

Delayed Postpartum Hemorrhage Resulting From Uterine Artery Pseudoaneurysm Rupture

Background Rupture of a uterine artery pseudoaneurysm is an uncommon, but life-threatening, cause of postpartum hemorrhage. Cesarean delivery is the most common cause. Objectives Prompt recognition and management are critical in severe vaginal bleeding. A diagnosis of pseudoaneurysm of the uterine artery can be established radiologically, such as with color Doppler ultrasonography and computed tomography. Angiography confirms the diagnosis. This condition can be treated with selective arterial embolization. Case Reports We describe three cases of postpartum hemorrhage caused by rupture of pseudoaneurysms of the uterine artery after cesarean section. Conclusion Uterine arterial pseudoaneurysm rupture is an infrequent, life-threatening cause of delayed postpartum hemorrhage requiring prompt diagnosis and treatment. Early crystalloid infusion and blood transfusion are essential. The initial management and stabilization of uterine artery pseudoaneurysm postpartum hemorrhage requires aggressive resuscitation. Arterial embolization should be considered the definitive treatment.

Uterine Artery Pseudoaneurysm Rupture: A Life-Threatening Presentation of Vaginal Bleeding

Uterine artery pseudoaneurysm rupture is a rare, yet life-threatening, cause of postpartum hemorrhage. Prompt recognition and management are critical in severe vaginal bleeding. In this case, diagnosis by bedside ultrasonography and initial management with vaginal packing and fluid resuscitation were performed in the emergency department. Definitive treatment by selective arterial embolization was performed to achieve hemostasis. This article discusses options available in the diagnosis, management, and treatment of uterine artery pseudoaneurysm hemorrhage.