Effective salvage of acute massive uterine bleeding using intrauterine balloon tamponade in a uterine adenomyosis patient on dienogest

Abstract

We present the case of a 37-year-old nulliparous woman in whom acute massive uterine bleeding during dienogest therapy was successfully treated using intrauterine balloon tamponade. Abnormal uterine bleeding and several cases of profuse bleeding causing severe anemia in association with dienogest therapy have been reported, but this is the first reported case involving hypovolemic shock. While successful control of postpartum hemorrhage with intrauterine balloon tamponade has been well described, applications for non-obstetric bleeding, particularly in the presence of underlying diseases, such as adenomyosis, have only rarely been reported. This procedure can be easily, promptly, and safely implemented without analgesia, anesthesia, or laparotomy; it can be used with a minimally dilated external cervical os or narrow uterine cavity; and it can preserve fertility.

Cardiac arrest due to massive hemorrhage from uterine adenomyosis with leiomyoma successfully treated with damage control resuscitation

“…To summarize, our patient suffered massive genital bleeding originating from severe uterine adenomyosis with leiomyoma. It was previously reported that uterine bleeding might occur with adenomyosis, especially when dienogest was administered, as in the present case . The treatment options for uterine bleeding include pharmacological treatment, angiographic embolization, balloon tamponade, gauze packing, and hysterectomy .…”

Genital bleeding hemostasis in gynecologic neoplasm with balloon tamponade: New treatment option

“…Foley catheter insertion was also reported for massive uterine bleeding due to uterine adenomyosis following dienogest . A 9‐Fr Foley catheter was inserted under ultrasonography, and hemostasis was achieved.…”

“…A 9‐Fr Foley catheter was inserted under ultrasonography, and hemostasis was achieved. The inflation volume was 3 mL and it was removed the next day . Balloon tamponade can be placed in numerous sites, not only in the uterine cavity for obstetrics, but also in the vagina or endocervix.…”

“…Regarding the uterine bleeding complication in balloon tamponade, persistent hypomenorrhea and abdominal pain have been reported in endometrial bleeding . Endometrial necrosis and infection is also possible, but previous reports have been confined to diseases of the uterine endometrium . Furthermore, balloons may not be able to be fixed in place, thus there is a risk of them coming out or of changing location.…”

“…The inflation volume was 3 mL and it was removed the next day. 11 Balloon tamponade can be placed in numerous sites, not only in the uterine cavity for obstetrics, but also in the vagina or endocervix. The characteristics of the various hemostatic methods are listed in Table 2.…”