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

Rava L, Laura Rava, Rüdiger Hoffmann, Hoffmann R, Krämer B, Bernhard Krämer, Markus Hoopmann, Hoopmann M
Ultraschall in der Medizin (Stuttgart, Germany : 1980) · 2021 · vol. 42(05) , pp. 447–449 · doi:10.1055/a-1528-1282 · PMID:34598299 · W3203769174
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A case report details a 52-year-old female patient who developed a uterine artery pseudoaneurysm three months post-endometriosis surgery, successfully treated with transarterial embolization.

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This case report describes a 52-year-old woman who presented with left-sided abdominal pain and anemia three months after undergoing surgery for extended deep infiltrating endometriosis. Diagnostic imaging, including transvaginal ultrasound and angiography, identified a ruptured pseudoaneurysm of the left uterine artery accompanied by a large capsulated hematoma and urinary congestion. The medical team successfully treated the condition through emergency selective transarterial embolization, which stopped the bleeding and allowed for the patient's discharge in good condition. This paper is centrally about endometriosis — specifically documenting a rare vascular complication arising from deep infiltrating disease following surgical intervention.

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Abstract

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.
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Subscribe to RSS DOI: 10.1055/a-1528-1282 Pseudoaneurysm of the uterine artery – a rare complication in a patient with deep infiltrating endometriosis Pseudoaneurysma der Arteria uterina – eine seltene Komplikation bei einer Patientin mit tief infiltrierender EndometrioseAuthors 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. Publication History Article published online: 01 October 2021 © 2021. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany - References - 1 Saad NEA, Saad WEA, Davies MG. et al. Pseudoaneurysms and the Role of Minimally Invasive Techniques in Their Management 1. Radiographics 2005; 25 (Suppl. 01) S173-S189 - 2 Morgan R, Belli AM. Current Treatment Methods for Postcatheterization Pseudoaneurysms. J Vasc Interv Radiol 2003; 14: 697-710 - 3 Dohan A, Soyer P, Subhani A. et al. Postpartum Hemorrhage Resulting from Pelvic Pseudoaneurysm: A Retrospective Analysis of 588 Consecutive Cases Treated by Arterial Embolization. Cardiovasc Inter Rad 2013; 36: 1247-1255 - 4 Zwimpfer TA, Monod C, Redling K. et al. Uterine pseudoaneurysm on the basis of deep infiltrating endometriosis during pregnancy – a case report. Bmc Pregnancy Childb 2021; 21: 282

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Outcome instruments

rASRM

Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Aneurysm, False Aneurysm, False Aneurysm, False Endometriosis Endometriosis Endometriosis Female Female Humans Humans Uterine Artery Uterine Artery Uterine Artery

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References (4)

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