2022 Volume 38 Issue 1 Pages 131-138
Uterine artery pseudoaneurysms frequently rupture and cause a hemorrhage. Such a pseudoaneurysm is a potential complication of vascular injury resulting from inflammation, trauma, or surgery, but it rarely happens after an ectopic pregnancy. Many cases have been treated by transcatheter uterine arterial embolization (UAE) or disappeared spontaneously, but there is no report of a case treated by laparoscopic surgery. We successfully treated a patient with a uterine artery pseudoaneurysm that occurred after conservative treatment for an interstitial pregnancy by performing laparoscopic surgery.
A 40-year-old woman was referred to our hospital for a suspected incomplete abortion and vaginal hemorrhage; we diagnosed an interstitial pregnancy. After she was administered methotrexate, her hCG value decreased and the pregnancy part got smaller. We diagnosed a uterine artery pseudoaneurysm based on the results of contrast enhanced computed tomography (CECT), which revealed a pooling of contrast medium in the interstitial part. On the same day as the CECT examination, we performed UAE, but it could not stop the hemorrhage completely. We performed laparoscopic surgery 1 week later. The blood vessels from the omentum, the left ovarian artery, and the right side of uterus flowed into the swollen interstitial part. We sealed the blood vessels, cut off the uterine artery pseudoaneurysm, and sewed muscle layer.
Although uterine artery pseudoaneurysms have been successfully treated by UAE, in the present case, the hemorrhage could not be stopped by UAE because of the many collateral vessels. In similar cases, laparoscopic surgery could be the most effective treatment.
