Active bleeding from endometriotic lesion around broad ligament of uterus during hysteroscopic surgery: A Case Report

Kana Tamai, S. Baba, Koya Maeda, Ayane Maki, Kôtaro Oshima, M Morioka, Katsuyuki Adachi, Toshio Igarashi
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2024 · vol. 40(2) , pp. 67–72 · doi:10.5180/jsgoe.40.2_67 · W4409321314
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-08 ⓘ

This case report details the successful management of active bleeding from a broad ligament endometriotic lesion, discovered during hysteroscopic myomectomy with uterine perforation.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-12 · read from full text ⓘ

This paper is a case report describing active arterial intraperitoneal bleeding originating from an endometriotic lesion around the broad ligament that occurred during hysteroscopic myomectomy. A 35-year-old woman with a submucosal myoma and a history of a left 5 cm ovarian endometriotic cyst (reduced with low-dose estrogen and progestin) underwent hysteroscopic myomectomy, during which the uterus was accidentally perforated and large intraperitoneal bleeding persisted despite initial repair. Laparoscopic observation identified the active bleeding source as an endometriotic lesion near the broad ligament (no endometrioma was found there), and bleeding was stopped using a vascular clip plus suturing; she had an uncomplicated recovery. This paper is centrally about endometriosis — it documents a rare intraoperative complication of active bleeding from a broad-ligament endometriotic lesion during hysteroscopic surgery.

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Abstract

We report a case of treatment of active bleeding from endometriotic lesion around the broad ligament of the uterus that occurred during hysteroscopic surgery. A 35-year-old woman, gravida 0, was diagnosed with submucosal myoma. Although she had also suffered from left 5 cm dia. ovarian endometriotic cyst, which had been shrunk by low-dose estrogen and progestin, only hysteroscopic myomectomy was performed. Surgical procedure performed was as follows: 1. Hysteroscopic myomectomy was performed, during which the fundus of uterus was inadvertently perforated. 2. A large amount of intraperitoneal bleeding was observed under laparoscopy. 3. We immediately repaired the perforation site; however, the intraperitoneal bleeding was not stopped. 4. Careful observation revealed active bleeding from the endometriotic lesion around the broad ligament of uterus, while no endometrioma was found in the area. 5. Bleeding was stopped by clipping the bleeding point with Vascular Clip (PL594R) and suturing the same point. The patient progressed favorably after the surgery without any complications such as massive rebleeding. Three months after the operation, she started to attempt to conceive. Active bleeding from endometriotic lesion around the broad ligament of uterus during hysteroscopic surgery is a rare complication. However, attention should be paid to it when the patient has a history of endometriosis.
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症例報告 子宮鏡下子宮筋腫摘出術中に広間膜後葉の子宮内膜症病変癒着部より動脈性の腹腔内出血を呈し、腹腔鏡下にて止血し得た１例 2024 年 40 巻 2 号 p. 67-72 詳細 抄録 We report a case of treatment of active bleeding from endometriotic lesion around the broad ligament of the uterus that occurred during hysteroscopic surgery. A 35-year-old woman, gravida 0, was diagnosed with submucosal myoma. Although she had also suffered from left 5 cm dia. ovarian endometriotic cyst, which had been shrunk by low-dose estrogen and progestin, only hysteroscopic myomectomy was performed. Surgical procedure performed was as follows: 1. Hysteroscopic myomectomy was performed, during which the fundus of uterus was inadvertently perforated. 2. A large amount of intraperitoneal bleeding was observed under laparoscopy. 3. We immediately repaired the perforation site; however, the intraperitoneal bleeding was not stopped. 4. Careful observation revealed active bleeding from the endometriotic lesion around the broad ligament of uterus, while no endometrioma was found in the area. 5. Bleeding was stopped by clipping the bleeding point with Vascular Clip (PL594R) and suturing the same point. The patient progressed favorably after the surgery without any complications such as massive rebleeding. Three months after the operation, she started to attempt to conceive. Active bleeding from endometriotic lesion around the broad ligament of uterus during hysteroscopic surgery is a rare complication. However, attention should be paid to it when the patient has a history of endometriosis. © 2024 日本産科婦人科内視鏡学会

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endometriosisendometrioma

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