Uterine artery pseudoaneurysm caused by an uterine manipulator; A case report

Abstract

  A uterine artery pseudoaneurysm (UAP), which usually occurs after deliveries or miscarriages, is known to cause massive vaginal bleeding and may even be fatal in some cases. We report a rare case of UAP secondary to the use of a uterine manipulator during laparoscopic surgery.

  A 40-year-old woman presented with a right ovarian cyst and infertility and underwent uneventful laparoscopic ovarian cystectomy. She returned one month later with massive vaginal bleeding. Transvaginal ultrasonography revealed a cystic lesion (20 mm) with a pulsating blood flow near the uterine endometrium. We suspected UAP secondary to uterine manipulator-induced injury during the previous laparoscopic surgery, and she was referred to a tertiary center for further evaluation.

  Emergency angiography revealed UAP to the left of the uterus, and the patient underwent uterine artery embolism (UAE). Following UAE, the patient conceived via assisted reproductive technology and delivered transvaginally subsequently.

  A uterine manipulator is a common device used during gynecological laparoscopic surgery. We report UAP attributable to uterine manipulator-induced injury. Clinicians should be mindful that a uterine manipulator may injure the uterine endometrium with a consequent risk of UAP.