A case of unexpected hemorrhagic shock 49 days after total laparoscopic hysterectomy

Abstract

　Genital bleeding after total hysterectomy is minor and often relieved with follow-up and gauze compression. In this study, we report a case of shock from profuse genital bleeding on the 49th day after total laparoscopic hysterectomy (TLH).

　―A 42-year-old woman with uterine fibroids underwent total laparoscopic hysterectomy at our hospital. The postoperative course was uneventful. On day 49 after surgery, she noticed heavy genital bleeding without any cause and was referred to the emergency clinic. On arrival, she developed hemorrhagic shock, and she underwent blood transfusion and contrast-enhanced CT. There was no apparent contrast leakage. After her general condition had stabilized, she was transferred to our hospital. There was no vaginal dissection, and a diagnostic laparoscopy was performed. The absence of intra-abdominal bleeding suggested retroperitoneal hemorrhage, but there were no active bleeding sites. She was subsequently discharged without re-bleeding. We speculated that the bleeding was due to a ruptured of uterine artery pseudoaneurysm, because the acute phase had passed and there was no obvious vaginal dissection.

　It has been suggested that acute phase CT may not confirm contrast leakage or aneurysm due to circulatory failure. Similar events, although rare, can be very serious when they occur. For early detection, color Doppler testing for abnormal blood flow behind the vaginal stump is suggested.