Korean J Obstet Gynecol.  2012 Feb;55(2):137-141. 10.5468/KJOG.2012.55.2.137.

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

• Lee MR
• Kim MJ
• Jeon HJ
• Choi SA
• Kim YS
• Bae DH
• Goo DE

• KMID: 2078129
• DOI: http://doi.org/10.5468/KJOG.2012.55.2.137

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.

Keyword

Laparoscopic supracervical hysterectomy; Pseudoaneurysm; Arterial embolization

MeSH Terms

Aneurysm, False
Arteries
Cervix Uteri
Female
Glycosaminoglycans
Hematoma
Hemorrhage
Humans
Hysterectomy
Parents
Rupture
Trophoblasts
United Nations
Ureter
Uterine Artery
Glycosaminoglycans

Figure

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  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.

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