A case of vulvar hematoma with rupture of pseudoaneurysm of pudendal artery

Abstract

Vulvar hematomas are uncommon outside of the obstetric population and may be the result of trauma to the perineum. Vulvar hematomas most often present with low abdominal pain and urologic and neurologic symptoms. The vulva has rich vascularization that is supplied by the pudendal artery, a branch of the anterior division of the internal iliac artery. We describe a rare case of a 15-cm-sized vulvar hematoma with the suggested rupture of a pseudoaneurysm of the left pudendal artery without trauma injury. A 14-year-old girl presented with sudden pain and swelling in her left labium and was successfully treated with selective arterial embolization and surgical evacuation. We provide a literature review and discuss patient treatment and management strategies.

Spontaneous vulvar hematoma as a rare manifestation of congenital hypofibrinogenemia. Case report

“…(15) Although in both cases it is usually associated with perineal trauma, vulvovaginal hematomas can rarely be triggered by spontaneous injury to a blood vessel or result from a hematological disorder. (16) In this case, a hematological disorder caused an expansive vulvar hematoma in a patient with a history of congenital fibrinogen disorder.…”

“…First-line treatment for a vulvovaginal hematoma is usually conservative, especially when the hematoma has a small to moderate size; however, if the hematoma has expansive behavior (16,17) or is >12cm, it is usually associated with decreased hematocrit, hemodynamic disorders, and transfusion requirement, suggesting the need for surgical management. Still, there is no clear scientific evidence to support this approach and the optimal timing for surgical management remains controversial.…”

Spontaneous Bilateral Vulvar Hematoma During Pregnancy

“…2,8 Selective embolization has been used in obstetrics and gynecology to treat neoplastic disease of the genital tract, trauma to the pelvis, postpartum hemorrhage, and bleeding from unknown origins without causing complications. 3,9 Conclusions Incision and evacuation of the hematoma clot may be the best intervention option for pregnant patients. Blood-clot evacuation and ligation of bleeding points with surgery may be performed to prevent necrosis and infection.…”

“…Against postpartum bleeding or nonobstetric hematoma, advanced selective angiography embolization can be used as an effective alternative to surgery for hemorrhage. 1,3 It is generally agreed that, if the hematoma is significantly larger or expanding, intervention is required. 2,8 Surgery involves an incision and evacuation of the hematoma with ligation of any bleeding points.…”

“…[1][2][3][4] Most obstetric hematomas have been described as resulting from an uncommon complication of childbirth. Puerperal hematomas will occur mostly in the presence of episiotomy or laceration but can also occur from spontaneous rupture of a blood vessel, mostly in the presence of an aneurysm, with atherosclerosis, connective-tissue disease, infection, and trauma.…”