Pseudoaneurysm of the uterine artery – a rare complication in a patient with deep infiltrating endometriosis

A 52-year old female patient was referred to our tertiary center due to left sided abdominal pain radiating to the left flank 3 months after abdominal surgery of extended deep endometriosis (rASRM Stage IV) with right adnexectomy, left salpingectomy and adhesiolysis. The patient also showed clear signs of anemia being very fatigued and short of breath. Transvaginal ultrasound (including dopplersonography) revealed signs of a covered ruptured pseudoaneurysm of the left uterine artery. A capsulated hematoma with a diameter of 8,5 cm and a central pulsating cystic area could be demonstrated. Dopplersonography revealed a turbulent blood flow rising from the uterine artery with high velocities into this pseudoaneurysm. ([Fig. 1], [2], [3]) A contrast-enhanced CT scan and an angiography confirmed the sonographic diagnosis. ([Fig. 4]) Hemoglobin concentration was decreased to a level of 7,9 g/dl, furthermore there was as a grade III° left-sided urinary congestion. Hence an emergency selective transarterial embolization of the left uterine artery with liquid embolic agent was performed, successfully stopping the blood flow. The rest of the stay turned out to be inconspicuous and the patient was discharged into outpatient care in good general condition.