Transarterial embolization of a nonpuerperal traumatic vulvar hematoma

Abstract

Nonpuerperal traumatic vulvar hematomas are relatively uncommon. Conservative and surgical management are the usual treatment options for traumatic vulvar hematomas. There is no report of transarterial embolization of nonpuerperal traumatic vulvar hematoma. We report a 35-year-old woman who presented with a vulvar hematoma caused by an accidental fall on a toy of her child. The hematoma was expanding and was refractory to conservative treatment. A computed tomography (CT) scan revealed active extravasation of contrast material from the left internal pudendal artery. We performed transarterial embolization of the left internal pudendal artery. The left external pudendal artery, which had an anastomosis with the left internal pudendal artery, was also embolized. Postembolization angiography demonstrated no further extravasation of contrast material. We believe that transarterial embolization can be an effective treatment of nonpuerperal traumatic vulvar hematomas when conservative treatment fails.

Severe traumatic vulva hematoma in teenage girl

“…The hematoma should be evacuated and definitive hemostasis obtained . Selective arterial embolization is an appropriate alternative to traditional surgical exploration . This may be particularly useful in the high‐risk operative candidate with prohibitive comorbidities, as the procedure does not require a general anesthetic.…”

“…This may be particularly useful in the high‐risk operative candidate with prohibitive comorbidities, as the procedure does not require a general anesthetic. It may also be advantageous in the situation where the degree of soft tissue trauma makes careful delineation of the anatomy difficult . Arterial embolization may also facilitate shorter hospital stays .…”

“…However, traumatic nonobstetric vulva hematomas are rare. They may arise secondary to blunt trauma sustained during a fall from height , sexual assault, foreign body insertion, and coitus . Although most are small and pose little threat to the patient, nonobstetric hematomas may become large enough to cause hemodynamic instability.…”

Non‐obstetric vulval trauma

“…The use of transperineal sonography in determining the extent and resolution of haematomas can assist in expectant management of this condition . Angiographic embolisation of vulvo‐vaginal haematomas has been reported in the post‐partum patient and the non‐obstetric patient with a vulval haematoma . Conservative and surgical management have both been advocated with conservative management in the absence of acute haematoma expansion favoured in the majority of reports .…”

“…14 Angiographic embolisation of vulvo-vaginal haematomas has been reported 15 in the post-partum patient and the non-obstetric patient with a vulval haematoma. 16 Conservative and surgical management have both been advocated with conservative management in the absence of acute haematoma expansion favoured in the majority of reports. 17,18 Associated injuries were only documented in two cases in this study.…”