Evacuation of a large traumatic vulvar haematoma with an intravaginal cosmetic approach

Abstract

A healthy youngwoman presented 3 days after a jet ski accident with a large left vulvar haematoma measuring 12 cm. Immediately postinjury, she was managed conservatively in the emergency room of another hospital. However, the haematoma continued to slowly expand. She presented to our clinic with difficulty walking and severe discomfort. Decision was made to drain the haematoma surgically. The patient was sceptical to have scarring on her vulva. Thus, the haematoma was evacuated by a vertical incision on the left vaginal sidewall. After evacuation and achieving haemostasis, the was closed with two interrupted sutures. Edges of the incision were secured similar to marsupialisation with five interrupted sutures to allow continual drainage. Her discomfort resolved immediately postsurgery and she had an uncomplicated postoperative course. The intravaginal approach yielded superior aesthetic result with no scarring on the external vulva.

Non-Obstetric Traumatic Vulvar Hematoma Managed in a Low-Resource Setting: A Case Report of a Rare Condition

“…In a case report of a patient with non-obstetric vulvar hematoma, the patient underwent transarterial embolization of the left internal pudendal artery [ 17 ]. Another study has mentioned performing a vaginal incision to drain a large hematoma to prevent scarring in the vulva region [ 3 ]. In innovative treatment approaches, a vaginal incision for draining vulvar hematomas and performing pudendal artery embolization have shown promising esthetic results, particularly in well-equipped healthcare settings.…”

“…The scarcity of literature on the treatment modalities of non-obstetric vulvar hematomas can be attributed to the limited number of reported cases and the absence of standardized practice guidelines [ 3 ]. Hence, there is a need for further research in this field.…”

“…In a study involving 20 women with non-obstetric traumatic vulvar hematoma, recent vulvar surgery was identified as one of the contributing factors [ 2 ]. The anatomical position of the vulvar region, combined with its ample vascularization through the internal pudendal artery, makes it prone to the formation of hematomas [ 3 ].…”

Large labial haematoma needing surgical intervention

“…1 2 Other causes include trauma, forceful intercourse, sexual abuse, injection into genital vessels and saddle injuries, as in this case relating to certain sporting activities (cycling, horse riding etc). [3][4][5] Most labial and vulval injuries can be managed with conservative measures, though on occasion require surgical intervention if functional impairments arise (micturition, defecation), or if there is acute haematoma expansion. 6 Contributors APW acquired and analysed clinical information.…”