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BMJ Case Reports 2018; doi:10.1136/bcr-2018-224656
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)
  • CASE REPORT

Uterine artery pseudoaneurysm with an anastomotic feeding vessel requiring repeat embolisation

  1. Darrien Rattray1
  1. 1Department of Obstetrics and Gynecology, University of Saskatchewan College of Medicine, Regina, Saskatchewan, Canada
  2. 2Department of Radiology, Regina General Hospital, Regina, Saskatchewan, Canada
  1. Correspondence to Dr Darrien Rattray, darrien.rattray{at}gmail.com
  • Accepted 16 June 2018
  • Published 11 July 2018

Summary

Uterine artery pseudoaneurysm (UAP) is a rare cause of delayed postpartum haemorrhage. Early diagnosis and endovascular management are effective in treating this condition. We present the case of a 36-year-old gravida 3, para 2 woman with delayed postpartum haemorrhage and endometritis following a spontaneous vaginal delivery. Ultrasound and catheter angiogram demonstrated a UAP arising from the distal aspect of the left uterine artery. Significant bleed persisted despite selective bilateral uterine artery embolisation. A repeat angiogram confirmed complete occlusion of bilateral uterine arteries, but abdominal aortogram demonstrated that the left ovarian artery was now feeding the pseudoaneurysm. A repeat embolisation procedure was performed to occlude the left ovarian artery. The patient was discharged the following day. Selective arterial embolisation is effective in the management of UAP. Persistent bleeding despite embolisation should raise the suspicion of anastomotic vascular supply and may require repeat embolisation.

Footnotes

  • Contributors All authors participated in patient care. The data collection was done by CQW. MN was involved in the analysis and interpretation of images. Literature review was performed by CQW. All authors contributed intellectual content to the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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