Embolization of the inferior mesenteric artery for post‐partum hemorrhage with a vaginal laceration: A case with unusual collateral supply

Abstract

A 36-year-old primipara woman was referred to the interventional department for management of severe primary post-partum hemorrhage with a vaginal laceration after a normal vaginal delivery. Angiography revealed that the superior rectal branch of the inferior mesenteric artery was one of the origins of persistent vaginal bleeding following embolization of both uterine arteries. The patient was successfully treated by selective embolization without other complications. Our case report highlights that the inferior mesenteric artery should be considered as an unusual extrauterine source for post-partum hemorrhage.

Inferior mesenteric artery embolization for persistent postpartum hemorrhage after sufficient bilateral iliac arteries embolization: safety and efficacy in eight patients

“…As embolic materials, various materials including GSP, a microcoil, or NBCA, were used in IMA embolization in this study. Although permanent embolic materials, such as NBCA, seem advantageous for achieving devascularization more effectively than using temporary embolic materials such as GSP, as the patient in a previous literature report, 3 as well as our study patients in whom temporary embolic materials were used, all showed successful hemostasis without rebleeding. There have been no embolization-related complications, such as bowel ischemia, and therefore suggesting that selective TAE of the superior rectal artery from the IMA is usually safe.…”

“…The most probable mechanism for superior rectal artery bleeding is injury to the rectal artery associated with birth canal expansion and laceration as well as extravasated blood through the torn lower uterine body, cervix or vagina. 3,5 The CT findings that the origin of the extravasated blood abutted the adjacent rectum in two patients in this study also suggest that the adjacent rectal wall was distended and injured. However, the absence of rectal bleeding in our study patients implies that the injury was not so severe to cause real rectal wall tear.…”

“…PPH from IMA seems quite uncommon as there have been less than 10 cases reported. [3][4][5][6] All of the reported cases as well as the current patients presented with primary PPH (within the first 24 h after delivery) and had vaginal delivery with a substantial degree of genital tract injury reflecting injury of the superior rectal artery manifesting immediately after vaginal delivery as a consequence of concurrent genital tract injury. Vital signs were unstable in two of the eight patients in this study, and DIC was associated in one of them, suggesting that bleeding from the superior rectal artery or associated bleeders can be quite massive.…”

“…There have been no embolization-related complications, such as bowel ischemia, and therefore suggesting that selective TAE of the superior rectal artery from the IMA is usually safe. 3,4,6 The volume ratio of NBCA to iodized oil is not fixed and as it varied from 1:2 to 1:6 in this study, and is preferable to be determined depending on the desired penetration distance.…”

Bilateral iliac artery aneurysm: A rare cause of postpartum recurrent hemorrhage

“…They reported that the hemorrhage was controlled by the selective embolization of the distal branches of the IMA. Kim et al (17) reported a patient with massive PPH due to damage of the collateral network between the superior rectal branch of the IMA and the vaginal artery following vaginal delivery and they controlled the hemorrhage with embolization. Vascular pathologies must be considered in patients with PPH with a delayed onset.…”