Maharana Nibedita, Behera Manas R, Mitra Suvradeep, Singh Sweta
Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND.
Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND.
Cureus. 2024 May 5;16(5):e59665. doi: 10.7759/cureus.59665. eCollection 2024 May.
Uterine arteriovenous malformation (AVM) is a potentially life-threatening condition. The vast majority of cases are acquired. Uterine artery embolization (UAE) is currently the treatment of choice for symptomatic women desiring future childbearing. However, there is no consensus on the number of UAE procedures that can be performed on an individual woman. We report a case of recurrent uterine AVM and discuss the challenges in diagnosis and management. A 35-year-old multiparous woman presented with heavy menstrual bleeding (HMB). She had been diagnosed with uterine AVM six years ago and had undergone two previous UAE procedures. Her abdominal examination revealed a healthy Pfannensteil scar. Bimanual examination revealed a normal-sized uterus that was firm, mobile, and fornices were free. Her haemoglobin was 10.2 g/dl. Greyscale two-dimensional ultrasound revealed a normal-sized uterus with multiple hypoechoic lesions in the myometrium. Colour Doppler ultrasound showed intense vascularity with multidirectional flow in the myometrium, suggestive of uterine AVM. In view of previous failed UAE procedures, she opted for a hysterectomy. A total abdominal hysterectomy with a bilateral salpingectomy was performed. Blood loss during the procedure was greater than average, and she was transfused with a unit of packed cells. Her post-operative course was uneventful. Histopathology confirmed the diagnosis of a uterine AVM. To conclude, the UAE is considered the treatment of choice for symptomatic women with uterine AVM desiring future childbearing. In cases of failure of UAE procedures, hysterectomy is therapeutic but may be associated with more than average blood loss.
子宫动静脉畸形（AVM）是一种可能危及生命的疾病。绝大多数病例是后天获得性的。子宫动脉栓塞术（UAE）目前是有生育意愿的有症状女性的首选治疗方法。然而，对于单个女性可进行的UAE手术次数尚无共识。我们报告一例复发性子宫AVM病例，并讨论诊断和管理方面的挑战。一名35岁经产妇因月经过多（HMB）就诊。她六年前被诊断为子宫AVM，此前已接受过两次UAE手术。腹部检查发现Pfannensteil切口愈合良好。双合诊检查发现子宫大小正常，质地硬，活动度好，阴道穹窿无异常。她的血红蛋白为10.2 g/dl。灰阶二维超声显示子宫大小正常，肌层有多个低回声病变。彩色多普勒超声显示肌层血管丰富，血流多向，提示子宫AVM。鉴于之前的UAE手术失败，她选择了子宫切除术。行全腹子宫切除术及双侧输卵管切除术。手术过程中的失血量大于平均水平，她接受了一个单位的红细胞输血。术后恢复顺利。组织病理学证实为子宫AVM。总之，UAE被认为是有生育意愿的有症状子宫AVM女性的首选治疗方法。在UAE手术失败的情况下，子宫切除术是一种治疗方法，但可能伴有大于平均水平的失血。
