Uterine artery pseudoaneurysm after treatment of cesarean scar pregnancy: a case report

Abstract

Background Pseudoaneurysms are formed when a local arterial wall ruptures, leading to hemorrhage and hematoma adjacent to the artery. Continuous perfusion of the injured artery increases the pressure in the lumen of the pseudoaneurysm. It may rupture and lead to massive hemorrhage that could be life-threatening. Cesarean scar pregnancy (CSP) is an ectopic pregnancy where the gestational sac is implanted in the cesarean scar. Uterine artery pseudoaneurysm (UAP) after CSP treatment is rare. Case presentation We report the case of a 36-year-old Chinese woman who presented with acute massive vaginal bleeding 53 days after transabdominal scar pregnancy excision. Doppler ultrasound confirmed UAP. Selective uterine artery embolization (UAE) failed because of the thin and curved blood vessels. The lesion decreased in size after transvaginal ultrasound-guided direct thrombin injection (UGTI); however, massive vaginal bleeding recurred and endangered the patient’s life. The uterus was removed thereafter. Conclusions UAP is a rare complication after CSP treatment that can lead to fatal massive hemorrhage. Ultrasound should be reexamined regularly after treatment of CSP. In case of unexplained vaginal bleeding, we should be alert to the existence of UAP and the possibility of rupture and take effective diagnosis and treatment measures promptly.

Life‐threatening pontine hemorrhage secondary to HELLP syndrome

“…In which case, despite occurring in a difficult to operate area, an early diagnosis and management of the IC bleed through surgical drainage, and BP control may have improved her outcome. 2,3…”

Clinical efficacy and re-pregnancy outcomes of patients with previous cesarean scar pregnancy treated with either high-intensity focused ultrasound or uterine artery embolization before ultrasound-guided dilatation and curettage: a retrospective cohort study

“…Complications such as abdominal pain, abortion and vaginal bleeding may occur in CSP. In severe cases, CSP may lead to uncontrolled vaginal bleeding, uterine rupture, and even the need for hysterectomy [ 3 , 4 ]. Therefore, early diagnosis is essential to avoid life-threatening complications [ 5 ].…”

Ultrasound Imaging of Acquired Myometrial Pseudoaneurysm: The Role of Manipulators as an Unusual Cause during Laparoscopic Surgery

“…Moreover, surgery can lead to pseudoaneurysm formation through direct injury or infection of one or all the layers of the vessel [ 6 ]. It usually occurs after cesarean delivery [ 7 ], after spontaneous or operative vaginal delivery and surgical abortion [ 1 ], as well as being a possible fatal cause of abdominal pain in a pregnant woman who had a uterine pseudoaneurysm due to deep endometriosis [ 8 ]. In the literature, it is further reported after gynecologic surgical procedures such as laparotomic, laparoscopic, and hysteroscopic myomectomy, excision of deep endometriotic lesions, conization of the uterine cervix [ 9 ], and other rare diseases, such as spontaneous thrombosis [ 10 , 11 ] and inflammatory conditions [ 12 , 13 ].…”