Endovascular Management of a Rare Cause of Pelvic Hemorrhage

[摘要] Background: Pelvic hemorrhage has a plethora of causes. Although an iatrogenic cause is not uncommon, most cases refer to a post-partum state as the common scenario. A post-hysterectomy pseudoaneurysm of uterine artery has been very rarely reported. The delayed presentation of hemorrhage can confuse the picture all the more. Timely angiographic detection and endovascular treatment of such patients can save them from a more invasive open surgery. Case Report: A young female presented with hemodynamic shock and fall in hemoglobin with a history of radical hysterectomy about one month back. Despite a normal appearing CT angiogram, she was taken up for conventional angiography as the index of suspicion of vascular leak was high. On pelvic angiography, she was diagnosed with a right uterine artery pseudoaneurysm, which was embolized with coils in the same sitting.  Later, she got discharged from hospital, without having undergone any further intervention. Conclusion: Angiography proved an invaluable tool, not just to determine the cause of bleeding in this case, but also to embolize the bleeding artery. This rare case scenario should be kept in mind in post-hysterectomy patients who present with significant hemorrhage even in delayed settings.

[学科分类] 生理学

[关键词] Hemorrhage;Hysterectomy;Interventional Radiology;Aneurysm;Uterine Artery Embolization.