子宮鏡下子宮筋腫摘出術後に仮性動脈瘤を生じ、大量出血のため子宮摘出が必要であった１例

抄録

　Uterine pseudoaneurysm is a potentially fatal complication that can occur after non-traumatic delivery/abortion and surgical procedures such as cesarean section and myomectomy. We encountered a case of pseudoaneurysm after hysteroscopic myomectomy, necessitating hysterectomy due to massive hemorrhage. A 40-year-old woman was referred to our institution with hypermenorrhea caused by submucous leiomyoma. The leiomyoma was resected with hysteroscopic surgery, which revealed a FIGO type 3 leiomyoma. A transvaginal ultrasonography at the routine follow-up visit after 14 days revealed a hypoechoic structure with a diameter of 2 cm in the uterine cavity. Color Doppler ultrasonography revealed pulsatile flow within the hypoechoic area. Thus, a pseudoaneurysm was suspected. She presented with excessive vaginal bleeding the same night. Contrast-enhanced computed tomography confirmed the rupture of the pseudoaneurysm. She was treated with hysterectomy.

　Hysteroscopic surgery can cause pseudoaneurysm that can be diagnosed early using Color Doppler ultrasonography. Pseudoaneurysm should be suspected if a hypoechoic cystic lesion is present at the myomectomy site after hysteroscopic surgery.