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Toshimitsu M, Iriyama T, Sato J, Abe O, Ichinose M, Sayama S, Seyama T, Sone K, Kumasawa K, Osuga Y. A Case of Ruptured Exophytic Uterine Artery Pseudoaneurysm without Specific Risk Factors That Manifested Seven Days after Vaginal Delivery. Case Rep Obstet Gynecol 2023; 2023:1637463. [PMID: 38046834 PMCID: PMC10693466 DOI: 10.1155/2023/1637463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 12/05/2023] Open
Abstract
A uterine artery pseudoaneurysm (UAP) is a life-threatening complication during pregnancy and postpartum. Early diagnosis of exophytic UAP rupture is difficult due to the absence of vaginal bleeding. This study reports the case of a 31-year-old postpartum woman who presented with abdominal pain and fever seven days after vaginal delivery, without symptoms of maternal shock. Ultrasonography revealed a ruptured exophytic UAP with hemoperitoneum, which was confirmed using computed tomography. Interventional radiology confirmed that the site of the pseudoaneurysm was at the level of the uterine artery bifurcation, and embolization was performed immediately after diagnosis using a coil and n-butyl-2-cyanoacrylate. The patient's symptoms were relieved, and she was discharged 12 days after the embolization. At eight months postpartum, the UAP was not visible on transvaginal ultrasonography. Exophytic UAP can occur even in the absence of specific risk factors such as cesarean section or endometriosis, and the UAP may not necessarily rupture immediately after delivery. Obstetricians must remain aware of the possibility of exophytic UAP rupture manifesting as abdominal pain with postpartum fever, rather than as unstable vital signs. This is the first report of an exophytic UAP that occurred at the level of the uterine artery bifurcation. Identification of the sites where exophytic UAP can occur can aid in the early diagnosis of the condition.
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Affiliation(s)
- Masatake Toshimitsu
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Takayuki Iriyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Jiro Sato
- Department of Radiology, Tokyo Metropolitan Police Hospital, 4-22-1, Nakano, Nakano-ku, Tokyo 164-8541, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Mari Ichinose
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Seisuke Sayama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Takahiro Seyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kenbun Sone
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Spontaneous Uterine Vessel Rupture During Pregnancy or in the Puerperium: A Review of the Literature. Obstet Gynecol Surv 2022; 77:227-233. [PMID: 35395092 DOI: 10.1097/ogx.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Spontaneous perinatal rupture of a uterine vessel is a rare occurrence that may lead to severe hemorrhage and requires prompt identification and management. Objective The aim of this study was to examine the etiologies, locations, diagnostic tools, treatment options, and risks in subsequent pregnancies when spontaneous rupture of a uterine vessel occurs in pregnancy. Evidence Acquisition A literature search was performed by university research librarians using the PubMed, CINAHL, and Web of Science search engines. Identified were 78 cases of perinatal spontaneous uterine vessel rupture and formed the basis for this review. Results Increased uterine blood flow during pregnancy may alter the integrity of pelvic vessels leading to increased risk of spontaneous rupture. The uterine artery is the most common site of vessel rupture; the second most common site is the uterine-ovarian plexus. The most common presentation is abdominal or pelvic pain, maternal vital sign abnormalities, and an absence of vaginal bleeding. Exploratory laparotomy and embolization (interventional radiology) have been reported as management options. Conclusions Spontaneous rupture of uterine vessels is a rare but potentially life-threatening complication of pregnancy that should be included in the differential diagnosis of pregnant patients presenting with an acute abdomen. Relevance Our aim is to increase the awareness of spontaneous vessel rupture during pregnancy to improve detection, management, and perinatal outcomes.
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Usman R, Jamil M, Rasheed M. True Aneurysm of the Uterine Artery in a Young Nulliparous Female: An Extremely Rare Vascular Entity. Ann Vasc Dis 2018; 11:542-544. [PMID: 30637012 PMCID: PMC6326040 DOI: 10.3400/avd.cr.18-00066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We present the first case of a large true uterine artery aneurysm, with a 5-cm diameter, in a 35-year-old nulliparous woman who presented with lower abdominal pain and dyspareunia. She underwent successful ligation and excision of the aneurysm using the Pfannenstiel approach. The diagnostic modalities and treatment option for such a case is discussed herein.
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Affiliation(s)
- Rashid Usman
- Department of Vascular Surgery Combined Military Hospital & Midcity Hospital, Lahore, Pakistan
| | - Muhammad Jamil
- Department of Surgery Combined Military Hospital, Peshawar Cantt, Pakistan
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Karmous N, Ayachi A, Derouich S, Mkaouar L, Mourali M. Rupture of uterine artery pseudoaneurysm: role of ultrasonography in postpartum hemorrhage management. Pan Afr Med J 2017; 25:136. [PMID: 28292098 PMCID: PMC5326051 DOI: 10.11604/pamj.2016.25.136.10676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/29/2016] [Indexed: 12/26/2022] Open
Abstract
Uterine artery pseudoaneurysm (UAP) rupture should be considered in case of late genital bleeding without obvious cause and lead to perform a sonographic examination with Doppler-scan. We report two cases of late post-partum hemorrhage from UAP diagnosed as such using color Doppler US. In order to avert life-threatening bleeding, prompt and accurate diagnosis should be made using color Doppler US since the latter plays a significant role in demonstrating the vascular nature of this anechoic uterine lesion.
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Affiliation(s)
- Narjes Karmous
- Department of Obstetrics and Gynecology, University Hospital of Bougatfa, Bizerte, Tunisia
| | - Amira Ayachi
- Department of Obstetrics and Gynecology, University Hospital of Bougatfa, Bizerte, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunisia
| | - Sadok Derouich
- Department of Obstetrics and Gynecology, University Hospital of Bougatfa, Bizerte, Tunisia
| | - Lassaad Mkaouar
- Department of Obstetrics and Gynecology, University Hospital of Bougatfa, Bizerte, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunisia
| | - Mechaal Mourali
- Department of Obstetrics and Gynecology, University Hospital of Bougatfa, Bizerte, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunisia
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Matsubara S, Takahashi H. Uterine artery pseudoaneurysm caused by non-obstetric pelvic surgery, manifesting as haemoperitoneum after vaginal delivery: Some clarifications. J OBSTET GYNAECOL 2016; 37:403. [PMID: 27919169 DOI: 10.1080/01443615.2016.1244815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Shigeki Matsubara
- a Department of Obstetrics and Gynaecology , Jichi Medical University , Tochigi , Japan
| | - Hironori Takahashi
- a Department of Obstetrics and Gynaecology , Jichi Medical University , Tochigi , Japan
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