Failed transarterial embolization of subserosal uterine arteriovenous malformation
A 24-year-old woman, gravida 1 para 0, was referred to our hospital with vaginal bleeding for a week. She had a dilatation and curettage due to a missed abortion at a local hospital two months ago. After the procedure, she received an ultrasound, and heard that there were no specific findings in uterus. She had normal menstrual cycles, and no other medico-surgical history.\nOn admission, she had moderate vaginal bleeding. Transvaginal gray and color Doppler ultrasound examination demonstrated abnormal findings of increased high-velocity blood flows within the posterior myometrium (), and anechoic cystic lesion with high velocity vascular flow on the fundus of the uterus (). There was no communication between the subserosal AVM and endometrial cavity. An abdominal aortogram confirmed enlarged bilateral uterine arteries and subserosal AVM (). The AVM was additionally supplied by left ovarian artery (). Embolization of the bilateral uterine arteries and left ovarian artery was performed as treatment of choice to spare fertility. After embolization, there was no significant flow to the subserosal type AVM (). The patient tolerated the procedure well, and was discharged without problem.\nOne month later, the patient presented to the emergency room with severe abdominal pain and distension without vaginal bleeding. On admission, her blood pressure was 95/60 mm Hg, and pulse rate was 115 beat per minute. Hemoglobin was 9.5 g/dL. Abdominopelvic computed tomography scan demonstrated that the fundal AVM of uterus was ruptured, and there was a large amount of hemoperitoneum in the abdominopelvic cavity (). By emergency exploratory laparotomy, about 3×3 cm sized subserosal type AVM was noted on the fundus that had ruptured and was bleeding profusely (). The ruptured AVM was removed, and successfully repaired. The hematoma in the abdominopelvic cavity was removed. After surgery, the patient recovered well, and was discharged at hospital day 6 without complications. Five weeks later the external surface and internal area of the uterus appeared normal on ultrasonic examination.