Department of Obstetrics and Gynecology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
J Minim Invasive Gynecol. 2010 Nov-Dec;17(6):687-91. doi: 10.1016/j.jmig.2010.06.004. Epub 2010 Jul 24.
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. Herein is described a case of UAP after cesarean section. The patient visited our emergency outpatient department 99 days after cesarean section because of abnormal uterine bleeding, which was diagnosed as UAP using color Doppler ultrasonography and contrast medium-enhanced computed tomography. Selective transcatheter arterial embolization was performed to resolve the lesion without complications. We also conducted a review to identify the demographic etiology of UAP. A PubMed search yielded 57 cases reported in the English literature. The most frequent cause of UAP was cesarean section, which accounted for 47.4% of all cases. The mean interval between the incident and the symptoms was approximately 2 weeks, regardless of cause. At analysis of 17 cases diagnosed within a day, it became evident 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.
子宫动脉假性动脉瘤（UAP）罕见发生，可在各种妇科或产科手术后发展。这种疾病的延迟诊断常导致危及生命的出血。本文描述了一例剖宫产后 UAP 病例。患者在剖宫产后 99 天因异常子宫出血就诊于我院急诊门诊，彩色多普勒超声和对比增强 CT 诊断为 UAP。采用选择性经导管动脉栓塞术治疗病变，无并发症。我们还进行了一项回顾性研究，以确定 UAP 的人口病因。在 PubMed 上检索到英文文献报道的 57 例病例。UAP 最常见的病因是剖宫产，占所有病例的 47.4%。无论病因如何，从发病到出现症状的平均间隔约为 2 周。对 17 例在 1 天内确诊的病例进行分析表明，血管造影（41.2%）、计算机断层扫描（29.4%）或彩色多普勒超声（29.4%）明确了明确的诊断。几乎所有病例（94.1%）均采用经导管子宫动脉栓塞术保守治疗。在破裂前进行适当治疗并保留生育能力，需要考虑鉴别诊断 UAP。
