Post‐partum hemoperitoneum: Do not miss false aneurysm as a cause of bleeding

Abstract

A 27-year-old woman underwent a first vaginal delivery at our institution. She returned four days after delivery, presenting with abdominal pain and an unexplained drop in her hemoglobin value, without external bleeding. The initial computed tomography abdominal scan revealed an isolated diffuse hemoperitoneum. A laparoscopy did not find the cause of bleeding. A second computed tomography scan, performed 15 days later, revealed hemoperitoneum associated with a false aneurysm of the right uterine artery. Treatment consisted of embolization of the uterine arteries, with clinical success. False aneurysms are a rare cause of intra-abdominal non-exteriorized bleeding in late post-partum hemorrhage.

Rupture of uterine artery pseudoaneurysm: role of ultrasonography in postpartum hemorrhage management

“…However, in the case of a UAP, visualization of the neck of the pseudoaneurysm at US may be difficult because of the small size of the parent artery [ 12 ]. Some authors had completed ultrasononography by angio computed tomodensitometry to confirm the diagnosis and to perform embolization in the same time [ 13 , 14 ]. In the present cases, color Doppler US helped to establish the diagnosis of UAP by displaying turbulent blood flow with the “yin-yang” mosaic pattern after initial identification on grayscale US.…”

A Case of Ruptured Exophytic Uterine Artery Pseudoaneurysm without Specific Risk Factors That Manifested Seven Days after Vaginal Delivery

“…A patient's hemodynamics are dependent on the rate and amount of blood loss due to ruptured UAP. The exophytic UAP did not rupture immediately postpartum in the current patient (postpartum day seven) or in a previously reported patient (postpartum day five) [ 9 ]. Therefore, the early diagnosis of UAP is difficult due to the variability of its clinical presentation and the interval between delivery and the onset of rupture.…”

“…The main symptoms of exophytic UAP include abdominal pain and hypotension without vaginal bleeding [ 7 , 9 ]. The current report is the first regarding a postpartum fever without hypotension.…”

“…Transarterial embolization is an effective therapeutic modality for UAP [ 20 , 21 ]. The embolic materials vary; coils are the embolization material of choice to reduce the risk of recurrent bleeding in patients with exophytic UAP [ 7 , 9 ]. The current patient was successfully treated via interventional radiology, with embolization using coils and NBCA.…”

“…A UAP most commonly presents as asymptomatic or postpartum hemorrhage with vaginal bleeding when it communicates with the uterine cavity. However, when a UAP develops outside of the uterus, it may be associated with hydronephrosis due to ureteral obstruction and hemoperitoneum [ 6 – 9 ].…”