Ultrasound Imaging of Acquired Myometrial Pseudoaneurysm: The Role of Manipulators as an Unusual Cause during Laparoscopic Surgery

An acquired uterine artery myometrial pseudoaneurysm can occur due to inflammation, trauma, or iatrogenic causes, such as surgical procedures, and can lead to profuse bleeding. The efficacy of uterine manipulators in gynecological surgery, particularly as a cause of a pseudoaneurysm, has been poorly discussed in the literature. In this paper, we discuss a case of a 39-year-old woman with profuse uterine bleeding that occurred seven days after operative laparoscopic surgery for endometriosis. The color Doppler ultrasound better evoked the arterial-like turbulent blood flow inside this cavity. These sonographic features were highly suggestive of uterine artery pseudoaneurysm, presumably related to a secondary trauma caused by the manipulator. The diagnosis was subsequently re-confirmed by angiography, and the patient was treated conservatively with uterine artery embolization. Ultrasound has been shown to be a valuable and safe tool for imaging pseudoaneurysm and guiding subsequent interventional procedures. Accordingly, we briefly review the most suitable manipulators used in benign gynecological surgeries to verify if the different types in use can guide the surgeon towards the correct choice according to surgical needs and thus prevent potentially dangerous trauma.

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Management of uterine artery pseudoaneurysm: advanced ultrasonography imaging and laparoscopic surgery as an alternative method to angio-computed tomography and transarterial embolization

Videosurgery and Other Miniinvasive Techniques ◽

10.5114/wiitm.2017.66503 ◽

2017 ◽

Vol 1 ◽

pp. 106-109 ◽

Cited By ~ 2

Author(s):

Michał Ciebiera ◽

Aneta Słabuszewska-Jóźwiak ◽

Kornelia Zaręba ◽

Grzegorz Jakiel

Keyword(s):

Computed Tomography ◽

Laparoscopic Surgery ◽

Uterine Artery ◽

Transarterial Embolization ◽

Artery Pseudoaneurysm ◽

Alternative Method ◽

Uterine Artery Pseudoaneurysm

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Uterine artery pseudoaneurysm after cesarean section: case report

Pulse ◽

10.3329/pulse.v7i1.23253 ◽

2015 ◽

Vol 7 (1) ◽

pp. 56-60

Author(s):

Afroza Parvin ◽

Monowara Begum ◽

Atiya Huda

Keyword(s):

Cesarean Section ◽

Uterine Artery ◽

Doppler Ultrasonography ◽

Post Partum ◽

Color Doppler ◽

Delayed Diagnosis ◽

Color Doppler Ultrasonography ◽

Radiology Department ◽

Artery Pseudoaneurysm ◽

Uterine Artery Pseudoaneurysm

Uterine artery pseudoaneurysm (UAP) occurs rarely and can develop after various gynecologic or obstetric procedures. The delayed diagnosis of this disease often results in life-threatening hemorrhage. Here is described a case of UAP after cesarean section. The patient visited gynecology outpatient department of AHD 60 days after cesarean section done outside AHD because of abnormal per vaginal bleeding. After her cesarean section she had undergone laparotomy outside AHD for post partum haemorrhage but those papers were not available. From there she was sent to our radiology department for color Doppler TVS examination and here she was diagnosed as a case of UAP using color Doppler ultrasonography. The most frequent cause of UAP is cesarean section, which accounted for 47.4% of all cases. Previous studies show that the definitive diagnosis was made at angiography (41.2%), computed tomography (29.4%), or color doppler ultrasonography (29.4%). Almost all cases (94.1%) were conservatively treated with transcatheter uterine artery embolization. Consideration of UAP in the differential diagnosis is crucial for proper treatment before rupture and to preserve fertility.Pulse Vol.7 January-December 2014 p.56-60

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

Pan African Medical Journal ◽

10.11604/pamj.2016.25.136.10676 ◽

2016 ◽

Vol 25 ◽

Cited By ~ 2

Author(s):

Narjes Karmous ◽

Amira Ayachi ◽

Sadok Derouich ◽

Lassaad Mkaouar ◽

Mechaal Mourali

Keyword(s):

Postpartum Hemorrhage ◽

Uterine Artery ◽

Artery Pseudoaneurysm ◽

Uterine Artery Pseudoaneurysm

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Assessment of extravasation on ruptured uterine artery pseudoaneurysm using contrast-enhanced ultrasonography during uterine balloon tamponade

Journal of International Medical Research ◽

10.1177/0300060519893166 ◽

2019 ◽

Vol 48 (4) ◽

pp. 030006051989316 ◽

Cited By ~ 1

Author(s):

Jun Takeda ◽

Shintaro Makino ◽

Chihiro Hirai ◽

Yota Shimanuki ◽

Tetsunori Inagaki ◽

...

Keyword(s):

Uterine Artery ◽

Color Doppler ◽

Uterine Cavity ◽

University Hospital ◽

Artery Pseudoaneurysm ◽

Balloon Tamponade ◽

Contrast Enhanced ◽

Contrast Enhanced Ultrasonography ◽

Uterine Balloon Tamponade ◽

Uterine Artery Pseudoaneurysm

Objective Contrast-enhanced ultrasonography (CEU) has been used in critical trauma situations to visualize extravasation; however, its use is limited in the field of obstetrics. Cases of ruptured uterine artery pseudoaneurysm (UAP) were analyzed to clarify the efficacy to CEU during uterine balloon tamponade. Methods Cases of ruptured UAP diagnosed at a teaching university hospital from January 2015 to December 2017 were retrospectively analyzed. UAP was diagnosed using color Doppler ultrasonography. Extravasation was identified using computed tomography and double checked using CEU with an intravenously administered contrast agent (Sonazoid; Daiichi Sankyo Company, Ltd., Tokyo, Japan) and an ultrasound instrument (HI VISION Preirus; Hitachi Aloka Medical, Ltd., Tokyo, Japan). A balloon was then inserted into the uterine cavity and inflated at the point of bleeding until extravasation ceased. Results Three patients exhibited ruptured UAP during the study period. Bleeding points were successfully identified using CEU in all cases, and hemostasis was achieved using uterine balloon tamponade. Obliteration of UAP was confirmed using magnetic resonance imaging, and no patients developed recurrent UAP or any complications. Conclusion CEU can be used at the bedside to promptly diagnose ruptured UAP. Moreover, it precisely facilitates balloon compression at the point of bleeding.

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Role of hysteroscopy in the diagnosis of uterine artery pseudoaneurysm: a case report

Journal of Obstetrics and Gynaecology ◽

10.1080/01443615.2019.1650261 ◽

2019 ◽

Vol 40 (7) ◽

pp. 1034-1035

Author(s):

Youhei Tsunoda ◽

Takashi Matsushima ◽

Koichi Yoneyama ◽

Toshiyuki Takeshita

Keyword(s):

Case Report ◽

Uterine Artery ◽

Artery Pseudoaneurysm ◽

Uterine Artery Pseudoaneurysm

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Postpartum hemorrhage caused by uterine artery pseudoaneurysm: A case report

Case Reports in Women s Health ◽

10.1016/j.crwh.2021.e00286 ◽

2021 ◽

Vol 29 ◽

pp. e00286

Author(s):

Danielle Glassman ◽

Ruchi Karsalia ◽

Issam Moubarak ◽

Mark V. Sauer ◽

Ashima Singla

Keyword(s):

Case Report ◽

Postpartum Hemorrhage ◽

Uterine Artery ◽

Artery Pseudoaneurysm ◽

Uterine Artery Pseudoaneurysm

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Overview of Neo-Vascular Lesions after Delivery or Miscarriage

Journal of Clinical Medicine ◽

10.3390/jcm10051084 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1084

Author(s):

Yuji Shiina

Keyword(s):

Arteriovenous Malformations ◽

Uterine Artery ◽

Spontaneous Regression ◽

Vascular Diseases ◽

Vascular Lesions ◽

Artery Pseudoaneurysm ◽

Retained Products Of Conception ◽

Products Of Conception ◽

Uterine Artery Pseudoaneurysm ◽

Retained Products

The concept of intrauterine neo-vascular lesions after pregnancy, initially called placental polyps, has changed gradually. Now, based on diagnostic imaging, such lesions are defined as retained products of conception (RPOC) with vascularization. The lesions appear after delivery or miscarriage, and they are accompanied by frequent abundant vascularization in the myometrium attached to the remnant. Many of these vascular lesions have been reported to resolve spontaneously within a few months. Acquired arteriovenous malformations (AVMs) must be considered in the differential diagnosis of RPOC with vascularization. AVMs are errors of morphogenesis. The lesions start to be constructed at the time of placenta formation. These lesions do not show spontaneous regression. Although these two lesions are recognized as neo-vascular lesions, neo-vascular lesions on imaging may represent conditions other than these two lesions (e.g., peritrophoblastic flow, uterine artery pseudoaneurysm, and villous-derived malignancies). Detecting vasculature at the placenta–myometrium interface and classifying vascular diseases according to hemodynamics in the remnant would facilitate the development of specific treatments.

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