A case of uterine pseudoaneurysm occured outside of the uterus that presented with hydronephrosis after spontaneous vaginal delivery

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  • KONISHI Nafuko
    Department of Obstetrics and Gynecology, Osaka City University, Graduate School of Medicine
  • MISUGI Takuya
    Department of Obstetrics and Gynecology, Osaka City University, Graduate School of Medicine
  • SUEMITSU Chiharu
    Department of Obstetrics and Gynecology, Osaka City University, Graduate School of Medicine
  • TAHARA Mie
    Department of Obstetrics and Gynecology, Osaka City University, Graduate School of Medicine
  • NAKANO Akemi
    Department of Obstetrics and Gynecology, Osaka City University, Graduate School of Medicine
  • TACHIBANA Daisuke
    Department of Obstetrics and Gynecology, Osaka City University, Graduate School of Medicine
  • TAMURA Kazutomi
    Department of Gynecology, Ishikiriseiki Hospital
  • KOYAMA Masayasu
    Department of Obstetrics and Gynecology, Osaka City University, Graduate School of Medicine

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Other Title
  • 経腟分娩後の水腎症を契機に診断された子宮外に存在した子宮仮性動脈瘤の1例
  • ケイチツブンベン ゴ ノ スイジンショウ オ ケイキ ニ シンダン サレタ シキュウ ガイ ニ ソンザイ シタ シキュウ カセイ ドウミャクリュウ ノ 1レイ

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Abstract

<p>Uterine artery pseudoaneurysm (UAP) is well known to develop after trauma to the uterus, such as cesarean section, and can be one cause of massive postpartum hemorrhage. We report a rare case of severe hydronephrosis accompanied by UAP after spontaneous vaginal delivery. A 40-year-old gravida two, para one woman was referred to our hospital for acute pyelonephritis after spontaneous vaginal delivery on the eighth postpartum day. An ultrasound showed right hydronephrosis and a right lateral mass measuring 3.1×2.9 cm beside the uterus, including anechoic lesion inside the mass. Color Doppler imaging of the anechoic lesion revealed marked turbulent blood flow representing systolic and diastolic blood flow, and UAP was suspected. Uterine artery embolization (UAE) was performed, and the patient’s hydronephrosis did not subsequently improve. Two months after UAE, the patient underwent a laparotomy with right ureter re-anastomosis, and the hydronephrosis improved.UAP can occur after spontaneous vaginal delivery, and it is thus necessary to take care of UAP when any mass lesions are confirmed beside the uterus, even after spontaneous vaginal delivery. UAP appearing outside of the uterus can be one cause of hydronephrosis, and surgical treatment is a valid option. [Adv Obstet Gynecol, 73 (3) : 313-320, 2021 (R3.8)]</p>

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