Recently, as laparoscopic myomectomy (LM) has become increasingly common, reports of intraoperative or postoperative complications have arisen. We experienced a case of massive hemorrhage resulting from a ruptured uterine arteriovenous fistula after LM.
A 24-year-old woman, nulligravid, presented with hypermenorrhea. She was diagnosed with an 8-cm intramyometrial leiomyoma of the posterior uterus with endometrial deformation. LM was performed. The myoma was soft, its boundaries were not clear, and there was extensive contact with endometrium. Operative time, blood loss, and enucleate weight were 181 minutes, 1,000 ml, and 298g. On a transvaginal ultrasound 25 days after the operation, a cystic lesion was noted in the area of the myomectomy. Color Doppler ultrasonography showed a fountain of blood streaming from a single artery into the cyst, while the size of the cyst was not changed. However, a massive hemorrhage erupted even as we were conferring with the patient in the medical examination room. She underwent emergency laparotomy on the same day. Pulsatile bleeding from a 1mm diameter artery in the wound of the myomectomy was observed. We examined the cyst in detail after ligating the artery. The wall of cyst was a structured fibrous myomatous capsule of a white color with a perforation of the intrauterine part. Blood infiltration and hematoma were not seen at all in the myometrium of the cyst.
We have performed LM on 406 patients in our hospital. This case was the first of its kind, so we are reporting it as a warning for consideration in the LM of the future.
