子宮仮性動脈瘤に対して経腟的腹腔鏡下子宮全摘術を行って良好な経過を辿った一例

抄録

　Uterine artery pseudoaneurysm is a rare and potentially life-threatening disease as it causes massive bleeding. We herein describe a patient who underwent vaginally assisted natural orifice transluminal endoscopic hysterectomy (VANH) for a uterine artery pseudoaneurysm that occurred following spontaneous abortion and who yielded a good outcome.

　The patient was a 37-year-old woman with six spontaneous vaginal deliveries and no history of previous miscarriages. A Spontaneous abortion occurred on X-17 month, followed by persistent abnormal uterine bleeding. On X-six month, she was treated with norgestrel and ethinyl estradiol. However, the bleeding did not stop. Thus, four cycles of leuprolide acetate were performed. Transvaginal ultrasonography revealed a hypoechoic area measuring 30 mm on the left lateral wall of the uterus with abundant blood flow spiraling around the mass. Furthermore, contrast-enhanced magnetic resonance imaging revealed a uterine artery pseudoaneurysm. The patient did not wish to have a child; thus, VANH and bilateral tubectomy were performed. No bleeding from the pseudoaneurysm occurred during the operation, and the patient achieved a good postoperative course.

　Uterine artery pseudoaneurysm causes heavy bleeding and requires early diagnosis and treatment. The treatment plan should be determined considering the patient's background and risk of rupture. In this case, due to the risk of bleeding from the pseudoaneurysm, VANH was performed, this is a safe and minimally invasive procedure that does not involve the use of manipulators and requires minimal manipulation of the uterine body.