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Lee, Kim, Jeon, Choi, Kim, Bae, and Goo: A case of treatment by embolization of uterine arterial pseudoaneurysm following laparoscopic supracervical hysterectomy
Case Report
Korean Journal of Obstetrics & Gynecology

Korean Journal of Obstetrics & Gynecology 2012; 55(2): 137-141.

Published online: 15 February 2012

DOI: https://doi.org/10.5468/KJOG.2012.55.2.137

A case of treatment by embolization of uterine arterial pseudoaneurysm following laparoscopic supracervical hysterectomy

Mi-Ra Lee, MD1, Min-Jeong Kim, MD1, Hye-Ji Jeon, MD1, Sl-A Choi, MD1, Yun-Sook Kim, MD1, Dong-Han Bae, MD1, Dong-Erk Goo, MD2

1Department of Obstetrics and Gynecology, Soonchunhyang University Chunan Hospital, University of Soonchunhyang College of Medicine, Chunan, Korea.

2Department of Interventional Radiology, Soonchunhyang University Chunan Hospital, University of Soonchunhyang College of Medicine, Chunan, Korea.

Corresponding author: Yun-Sook Kim, MD. Department of Obstetrics and Gynecology, Soonchunhyang University Cheonan Hospital, University of Soonchunhyang College of Medicine, 31 Suncheonhyang 2-gil, Dongnam-gu, Cheonan 330-721, Korea. Tel: +82-41-570-2150, Fax: +82-41-571-7887, drsook@schmc.ac.kr

Received 16 September 2011       Revised 1 December 2011       Accepted 14 January 2012

Copyright © 2012. Korean Society of Obstetrics and Gynecology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Laparoscopic supracervical hysterectomy is relatively new and minimally invasive surgery. The advantages of this operation are conserving the cervix. But it has complications like intraoperative bleeding, ureteral injury, bowel perforation and postoperative hematoma. Pseudoaneurysm can be acquired in association with trauma, previous surgery, trophoblastic disease. When a punctured artery does not seal completely, blood may escape and dissects the adjacent tissues, and collects in perivascular areas. If this maintains in communication with the parent vessel, a pseudoaneurysm could result. Typically the lesions are discovered because the patients have symptoms related to delayed rupture of the pseudoaneurysm, causing severe hemorrhage. Radiologic techniques have provided the opportunity to diagnose and treat pseudoaneurysm. We experienced a case of severe hemorrhage in the cervix four weeks following laparoscopic supracervical hysterectomy attributed to a pseudoaneurysm of the uterine artery and treated with arterial embolization.

Keywords: Laparoscopic supracervical hysterectomy, Pseudoaneurysm, Arterial embolization

Figures and Tables

Fig. 1
Transvaginal sonogram showed 52 × 32 mm sized hematoma (arrow) in the anterior wall of the cervix, and no hemoperitoneum in the pelvic cavity.
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Fig. 2
The computed tomogram showed high attenuated sac like structure and extravasation from it after contrast infusion (arrow).
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Fig. 3
The arterial angiography of the uterine artery showing pseudoaneurysm with a feeding vessel from the left uterine artery (arrow).
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Fig. 4
The Diagram. (A) About 50 mm sized hematoma like mass was shown anterior lip of cervix, so the internal os of cervix (arrow) was displaced downward. We incised the mass (arrow head) and inserted Jones-Pitzerald catheter drain. (B) Five days after the operation, the internal os of cervix (arrow) was back again.
kjog-55-137-g004

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