Combined laparoscopic and hysteroscopic management of cesarean scar pregnancy with temporary occlusion of bilateral internal iliac arteries

Abstract

Rationale:Cesarean scar pregnancy is a rare event that carries a risk of heavy hemorrhage and emergency hysterectomy. Many treatment modalities have been reported, but with no consensus. Here we report a case of combined laparoscopic and hysteroscopic treatment with temporary occlusion of the bilateral internal iliac arteries.Patient concerns:A 28-year-old woman presented with amenorrhea diagnosed as an 11-week cesarean scar pregnancy after an unsuccessful abortion. The patient's serum human chorionic gonadotropin level was 40,542 mIU/mL. Magnetic resonance imaging revealed a mass measuring 5 × 4.5 cm over the anterior uterine isthmus.Diagnose:Type III cesarean pregnancy.Interventions:Diagnostic and operative laparoscopy were performed to remove the pregnancy tissue and repair the scar dehiscence after temporary occlusion of the bilateral internal iliac arteries, followed by hysteroscopy to confirm no pregnancy remnants and to free intrauterine adhesions.Outcomes:Intraoperative and postoperative bleeding were minimal. The postoperative recovery was uneventful. Human chorionic gonadotropin normalized after 3 weeks.Lessons:Temporary occlusion of the bilateral internal iliac arteries seems to be a good strategy to reduce hemorrhage in cesarean scar pregnancy. Hysteroscopy is necessary to deal with intrauterine lesions.

Hysteroscopic Intact Removal of Angular and Caesarean Scar Pregnancy: A Novel and Markedly Less Invasive Surgical Treatment

“…However, laparoscopic surgery costs much more than hysteroscopy and curettage under ultrasonography and needs longer time of hospitalization [16]. As our study further confirms safety and effectiveness of hysteroscopy, treatment might be tailored taking into account hysteroscopic and laparoscopic options for cesarean scar pregnancy.…”

Emergency internal iliac artery temporary occlusion after massive hemorrhage during surgery of cesarean scar pregnancy: A case report

“…By temporarily blocking off both internal iliac arteries, blood flow to the uterus may be reduced by 48%, and pulse pressure can be reduced by 85%[ 18 ], resulting in better control of bleeding than with UAE because of vascular anastomosis between the internal iliac artery and its three offshoots (the uterine artery, the vaginal artery, and the internal pudendal artery). According to a review of recent literature[ 12 , 19 - 21 ], bilateral internal iliac artery temporary occlusion seems to be an effective strategy for reducing bleeding during CSP treatment without causing massive bleeding; hysteroscopy is required to deal with intrauterine lesions. Because the internal iliac artery occlusion is temporary, no serious complications are observed (Table 1 ).…”