Sharma Ankur M, Burbridge Brent E
College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
Case Rep Radiol. 2011;2011:373482. doi: 10.1155/2011/373482. Epub 2011 Sep 22.
Postpartum hemorrhage is a major cause of maternal mortality. Though uncommon, uterine artery pseudoaneurysm can follow uterine dilatation and curettage (D + C) and needs to be considered in the differential diagnosis. This 30-year-old G1P1 woman presented with right upper quadrant pain and vaginal bleeding. She was afebrile but her white blood count was significantly increased (22.2 × 10(9) /L). One week prior, she had undergone a Cesarean delivery which was complicated by hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP), fetal dystocia, and chorioamnionitis. Uterine dilatation and curettage (D & C) and placement of a Bakri intrauterine balloon, performed for suspected retained products of conception, failed to control her postpartum bleeding. The patient wished to have a hysterectomy only as a last resort in order to preserve fertility. Emergency uterine artery angiography revealed a left uterine artery pseudoaneurysm and contrast extravasation. The patient was successfully treated with selective embolization. Computed tomography (CT) later revealed dehiscence of her uterine Cesarean section incision with an intra-abdominal fluid collection. This collection was drained. She also developed disseminated intravascular coagulopathy (DIC) syndrome as well as multiple pulmonary emboli which were both successfully treated. We discuss this unique case of uterine artery pseudoaneurysm with associated uterine dehiscence.
产后出血是孕产妇死亡的主要原因。虽然罕见，但子宫动脉假性动脉瘤可继发于子宫扩张刮宫术（D+C）后，在鉴别诊断时需要考虑。这位30岁的初产妇（G1P1）出现右上腹疼痛和阴道出血。她无发热，但白细胞计数显著升高（22.2×10⁹/L）。一周前，她接受了剖宫产，术后并发溶血、肝酶升高和血小板减少综合征（HELLP）、胎儿难产和绒毛膜羊膜炎。因怀疑有妊娠物残留而行子宫扩张刮宫术（D&C）并放置了Bakri宫内球囊，但未能控制她的产后出血。患者希望仅在万不得已时才进行子宫切除术以保留生育能力。急诊子宫动脉血管造影显示左子宫动脉假性动脉瘤和造影剂外渗。患者通过选择性栓塞成功治愈。计算机断层扫描（CT）后来显示她的子宫剖宫产切口裂开并伴有腹腔内积液。该积液已引流。她还发生了弥散性血管内凝血（DIC）综合征以及多发性肺栓塞，两者均成功治愈。我们讨论了这例伴有子宫切口裂开的子宫动脉假性动脉瘤的独特病例。
