Spontaneous retroperitoneal hemorrhage caused by rupture of an ovarian artery aneurysm: a case report and review of the literature

Abstract

IntroductionSpontaneous rupture of an ovarian artery aneurysm is extremely rare. Although a majority of these cases have been associated with pregnancy, there have been recent reports and reviews of rare cases that were not directly associated with pregnancy. Transcatheter arterial embolization is considered to be an alternative therapy to surgery.Case presentationA 44-year-old Japanese woman, gravida 3 para 3, presented to our emergency room complaining of intermittent right flank pain. She had undergone a cesarean section 2 years previously, and had no history of abdominal trauma. On admission, her blood pressure was 115/78 mmHg, pulse 70 beats per minute, and hemoglobin concentration 9.8 g/dL. Abdominal ultrasonography and contrast-enhanced dynamic computed tomography revealed a large retroperitoneal hematoma. Findings on three-dimensional computed tomography angiography suggested ruptured aneurysm of her right ovarian artery. A selective right ovarian artery angiogram revealed a tortuous aneurysm. Transcatheter arterial embolization using N-butyl-2-cyanoacrylate was performed. The aneurysm was successfully embolized, and her course after embolization was uneventful. She has remained symptom-free during 3 months of follow-up.ConclusionsThis was a very rare case of a patient who had a retroperitoneal hemorrhage originating from an ovarian artery aneurysm. A review of published case reports found that contrast-enhanced computed tomography with reconstruction images is an excellent imaging tool. Diagnostic angiography and subsequent transcatheter arterial embolization are thought to be very effective for this condition.

Successful Embolization of a Ruptured Ovarian Artery Aneurysm in a Postmenopausal Woman: Case Report and Literature Review of Gonadal Artery Aneurysms

“…In the female gender, 18 cases were reported during the peripartum period 1,4 –20 and 6 were unrelated to pregnancy. 2,21 –25 The clinical manifestations are unspecific; and in the majority of cases, the formation of a retroperitoneal hematoma causes abdominal and flank pain, so rupture should be ruled out during the peripartum period in the presence of flank pain. 1,3 –20…”

“…1,2,4 Most available reports in the literature concerning ovarian artery aneurysms are related to rupture during the peripartum period, 1,5 –20 and with less frequency in nonpregnant women. 2,21 –25 On the other hand, aneurysms in the testicular artery have been described in 3 cases in the male gender. 3,26,27…”

Massive retroperitoneal hemorrhage secondary to femoral artery puncture

“…[ 1 – 12 ] Serious hemorrhage patients may manifest hemorrhagic shock and obvious local symptoms of oppression, and most patients have complicated and dangerous conditions. [ 2 , 3 ] Hence, it is one of the difficult problems in clinical diagnosis and treatment. Bleeding from the puncture site of the femoral artery and rupture of the ovarian artery alone may cause retroperitoneal hemorrhage, and the successive occurrence of both in a single patient made the condition more dangerous and complex, and greatly increased the difficulty of diagnosis and treatment.…”

Ruptured Ovarian Artery Pseudoaneurysm in a Postmenopausal Patient Treated with Transcatheter Embolization

“…We have been able to find only seven reported cases of ovarian artery pseudoaneurysms in postmenopausal patients [2][3][4][5][6][7][8]. Two additional cases were reported in females of age 44 and 48, the first two years after a cesarean section [9,10].…”