Diagnostic Computed Tomographic Angiography and Therapeutic Emergency Transcatheter Arterial Embolization for Management of Postoperative Hemorrhage after Gynecologic Laparoscopic Surgery

Takeda, Akihiro; Koyama, Kazuyuki; Mori, Masahiko; Sakai, Kotaro; Mitsui, Takashi; Nakamura, Hiromi

doi:10.1016/j.jmig.2008.02.010

Cited by 32 publications

(40 citation statements)

References 21 publications

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“…The findings with multidetector CT angiography include rates of extravasation similar to or even higher than those with conventional angiography, along with faster and more accurate location of bleeding sites (23,24). Portal phase images make it possible to differentiate among (a) active arterial bleeding from engorged vessels, (b) active venous bleeding, and (c) pseudoaneurysms in doubtful cases.…”

Section: Ct Protocolmentioning

confidence: 99%

Utility of Multidetector CT in Severe Postpartum Hemorrhage

Sierra

Burrel²,

Sebastiá³

et al. 2012

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Postpartum hemorrhage is one of the leading causes of maternal mortality worldwide. According to the time when postpartum hemorrhage develops, it is classified as (a) primary, or early, postpartum hemorrhage (within the first 24 hours after delivery) or (b) secondary, or late, postpartum hemorrhage (>24 hours to 6 weeks after delivery). Primary postpartum hemorrhage may be caused by uterine atony (75%-90% of cases), trauma of the lower portion of the genital tract, uterine rupture, uterine inversion, bladder flap hematoma, retention of blood clots or placental fragments, and coagulation disorders. Secondary postpartum hemorrhage may be caused by uterine subinvolution, coagulopathies, and abnormalities of the uterine vasculature. Extrauterine sources of bleeding include rectus sheath hematoma, direct arterial injuries, and the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Severe postpartum hemorrhage is a life-threatening condition that is diagnosed on the basis of the findings from clinical examination, with or without ultrasonography. Computed tomography (CT) and magnetic resonance imaging are useful in the characterization of postpartum hemorrhage when medical treatment fails. Multidetector CT has an important role when intraabdominal bleeding is suspected and can be considered in cases of recurrent bleeding after embolization, as well as for the evaluation of postsurgical complications. A proposed clinical and CT imaging algorithm for postpartum hemorrhage is presented. A multidisciplinary approach to postpartum hemorrhage is essential to optimize the role of diagnostic and interventional radiology in obstetric hemorrhage, to avoid hysterectomy and thus preserve fertility.

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Section: Ct Protocolmentioning

confidence: 99%

Utility of Multidetector CT in Severe Postpartum Hemorrhage

Sierra

Burrel²,

Sebastiá³

et al. 2012

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“…Emergency therapeutic arterial embolization is a safe and effective minimally invasive procedure for patients in whom postoperative hemorrhage develops after gynecologic laparoscopic surgery. 9 In our study, one patient with secondary hemorrhage in the TLH group underwent uterine artery embolization twice. Vaginal vault dehiscence is one of the rare complications after hysterectomy.…”

Section: Discussionmentioning

confidence: 80%

Secondary Hemorrhage After Total Laparoscopic Hysterectomy

Paul¹,

Prathap²,

Kaur³

et al. 2014

JSLS

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Background and Objectives:The purpose of this study is to estimate the cumulative incidence, patient characteristics, and potential risk factors for secondary hemorrhage after total laparoscopic hysterectomy.Methods:All women who underwent total laparoscopic hysterectomy at Paul's Hospital between January 2004 and April 2012 were included in the study. Patients who had bleeding per vaginam between 24 hours and 6 weeks after primary surgery were included in the analysis.Results:A total of 1613 patients underwent total laparoscopic hysterectomy during the study period, and 21 patients had secondary hemorrhage after hysterectomy. The overall cumulative incidence of secondary hemorrhage after total laparoscopic hysterectomy was 1.3%. The mean size of the uterus was 541.4 g in the secondary hemorrhage group and 318.9 g in patients without hemorrhage, which was statistically significant. The median time interval between hysterectomy and secondary hemorrhage was 13 days. Packing was sufficient to control the bleeding in 13 patients, and 6 patients required vault suturing. Laparoscopic coagulation of the uterine artery was performed in 1 patient. Uterine artery embolization was performed twice in 1 patient to control the bleeding.Conclusions:Our data suggest that secondary hemorrhage is rare but may occur more often after total laparoscopic hysterectomy than after other hysterectomy approaches. Whether it is related to the application of thermal energy to tissues, which causes more tissue necrosis and devascularization than sharp culdotomy in abdominal and vaginal hysterectomies, is not clear. A large uterus size, excessive use of an energy source for the uterine artery, and culdotomy may play a role.

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“…With the advent of multi-detector row helical CT scanners, three-dimensional CT angiography is becoming a useful diagnostic modality for identification of vascular disorders (2,10). In the present two cases of uterine artery pseudoaneurysm, after the initial identification of suspected vascular abnormality by ultrasonography, diagnostic CT angiography showed powerful diagnostic activity to demonstrate the precise location of the perfused sac of the pseudoaneurysm with its originating artery with minimal invasiveness.…”

Section: Discussionmentioning

confidence: 86%