Spontaneous post‐partum rupture of bilateral ovarian arteries treated with transarterial embolization

Abstract

Rupture of an ovarian artery aneurysm in the peripartum period occurs in both traumatic and atraumatic settings. To our knowledge, this is the first reported case of spontaneous atraumatic rupture of the bilateral ovarian arteries. This report describes a multiparous recently post-partum patient with abdominal pain and signs of hemodynamic compromise, the sequela of hemoperitoneum from ruptured bilateral ovarian arteries. With a multidisciplinary approach, this patient was successfully treated with transarterial embolization.

Spontaneous Rupture of a Right Gonadal Artery Aneurysm: A Case Report

“…Most cases are related to pregnancy or premenopausal peripartum period, although cases occurring during postmenopausal have also been documented [ 7 ]. Bilateral gonadal artery aneurysms are even more rare, with only one reported case [ 6 ]. It is important to note that most of the reported cases have been spontaneous.…”

“…These aneurysms may develop as a result of anatomical and physiological changes associated with pregnancy as the artery often gets dilated to accommodate for increased blood flow [ 1 , 3 , 8 , 9 ]. Repetitive pregnancies have also been suggested to cause a loss in arterial wall integrity, increasing susceptibility to aneurysms or ruptures [ 6 ]. When evaluating patients presenting with flank pain or abdominal pain resulting in periarterial hematoma formation, the goal is to identify the source of bleeding and perform necessary interventions.…”

“…Gonadal artery aneurysm is a relatively rare condition that can be life-threatening if left untreated. In the last 20 years, less than 30 cases of this condition have been reported [1][2][3][4][5][6]. Most cases are related to pregnancy or premenopausal peripartum period, although cases occurring during postmenopausal have also been documented [7].…”

Pregnancy-unrelated spontaneous rupture of a right ovarian artery aneurysm

“…Most cases of spontaneous rupture of an OAA have occurred in late pregnancy or the early postpartum period; however, pregnancy-unrelated rupture of an OAA has also been reported in a few cases [1 , 3] . According to a literature search using PubMed and Scopus data bases, to the best of our knowledge, 31 patients with spontaneous rupture of an OAA have been previously described in the English literature [1 , [3] , [4] , [5] , [6] , [7] ] ( Table 1 ). Of the 31 cases, 20 (64.5%) were related to pregnancy, and the remaining 11 (35.5%) were not related to pregnancy.…”

“…However, 29 (96.7%) of 30 patients with a history of pregnancy and delivery were multiparous, with an average parity of 3.7. In addition, aneurysms in the bilateral ovarian arteries have been reported [5] , and no OAA has been detected in nulliparous women. Rupture of the OAA in our patient was not associated with pregnancy but occurred in a multiparous woman.…”