Cardiac arrest due to massive hemorrhage from uterine adenomyosis with leiomyoma successfully treated with damage control resuscitation

Abstract

Case: A 57-year-old woman was transferred to our emergency department by ambulance with cardiopulmonary arrest caused by massive genital bleeding. Cardiopulmonary resuscitation, including massive transfusion, was carried out and the return of spontaneous circulation was achieved. A giant uterine tumor was considered the source of the bleeding. Although hysterectomy was necessary to achieve definitive hemostasis, the patient was unable to tolerate the operation because of hemodynamic instability, acidosis, and coagulopathy. Therefore, we undertook vaginal gauze packing and uterine artery embolization to attain temporary hemostasis, which resulted in hemodynamic stabilization. Abdominal hysterectomy for definitive hemostasis was carried out 10 h after the embolization.Outcome: The patient made a good post-surgical recovery without any complications. Conclusion: In treating hemorrhagic shock due to uterine leiomyoma, damage-control resuscitation may be useful as a bridge prior to definitive hemostasis through hysterectomy.

Possible association between adenomyosis and disseminated intravascular coagulation and thromboembolism: A systematic review

“…AUB caused by dienogest may occur from fragile and leaky endometrial vessels (17). Yagi et al (18) also presented a case of a 57-year-old woman with hemorrhagic shock and cardiopulmonary arrest caused by massive AUB from diffuse adenomyosis. She had very large adenomyosis with a diameter of 22x20x16 cm and was treated with dienogest therapy (18).…”

“…Yagi et al (18) also presented a case of a 57-year-old woman with hemorrhagic shock and cardiopulmonary arrest caused by massive AUB from diffuse adenomyosis. She had very large adenomyosis with a diameter of 22x20x16 cm and was treated with dienogest therapy (18). Moreover, Takamura et al (7) presented a case of a 45-year-old woman who necessitated a surgical management (i.e., emergency hysterectomy) due to refractory hemorrhagic shock occurred during dienogest therapy for adenomyosis.…”

“…Surgical procedures (e.g., dilatation and curettage) and pharmacological interventions (e.g., gonadotropins and progestin-only pill) can cause vascular injury, local microthrombosis, systemic coagulopathy and hemostastic abnormalities, and ultimately, life-threatening DIC and further massive AUB (15,19). Several studies have reported the risk of developing massive AUB in patients with adenomyosis treated with a dienogest-based regimen (7,(16)(17)(18)20). Of note, even women with diffuse adenomyosis, but without overt clinical manifestations already bear high levels of blood markers reflecting the activation of coagulation and fibrinolysis (10).…”