Zhang Jiayi, Jiang Guoliang, Lu Yiting, Wang Chunyu, Qiao Zhenguo, Yang Juanjuan
Department of Obstetrics, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to, Soochow Universityaq, Suzhou, China.
Department of Gastroenterology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China.
BMC Pregnancy Childbirth. 2025 Mar 19;25(1):315. doi: 10.1186/s12884-025-07466-7.
Bladder flap hematoma (BFH) is a rare complication associated with cesarean section (CS). Its pathogenesis is linked to insufficient hemostasis and bleeding at the incision site, leading to the formation of a hematoma between the bladder and the lower uterine segment (LUS). To the best of the authors' knowledge, no specific protocols have been formulated to guide the treatment of BFH.
A 29-year-old woman underwent an emergency CS due to relative cephalopelvic disproportion. Twenty-two hours after the CS, she developed pale red hematuria accompanied with a significant decrease in hemoglobin. The patient experienced two fainting episodes after standing and engaging in activity, along with vaginal bleeding. A bedside ultrasound revealed a 50 mm fluid-filled sonolucent area between the lower uterine segment (LUS) and bladder. Subsequently, the patient received conservative treatment with internal iliac artery embolization, antibiotics and blood transfusion, to avoid secondary laparotomy. The angiography and computer tomography examinations revealed the existence of uterine artery pseudoaneurysm and a large BFH. Her vital signs remained stable after the intervention and repeat ultrasonography demonstrated a significant reduction in the hematoma size.
Selective pelvic artery embolization as a conservative treatment can be a safe and effective option for large BFH, provided the patient remains clinically stable. This interventional therapy presents an innovative, non-surgical approach to a condition that is typically treated surgically and may carry the risk of irreparable complications.
膀胱瓣血肿（BFH）是剖宫产（CS）相关的一种罕见并发症。其发病机制与切口部位止血不充分和出血有关，导致膀胱与子宫下段（LUS）之间形成血肿。据作者所知，尚未制定出指导BFH治疗的具体方案。
一名29岁女性因相对头盆不称接受了急诊剖宫产。剖宫产术后22小时，她出现淡红色血尿，同时血红蛋白显著下降。患者站立及活动后发生两次昏厥发作，并伴有阴道出血。床边超声显示子宫下段（LUS）与膀胱之间有一个50毫米的液性无回声区。随后，患者接受了保守治疗，包括髂内动脉栓塞、抗生素治疗及输血，以避免二次剖腹手术。血管造影和计算机断层扫描检查显示存在子宫动脉假性动脉瘤和巨大的膀胱瓣血肿。干预后患者生命体征保持稳定，重复超声检查显示血肿大小显著减小。
对于巨大膀胱瓣血肿，若患者临床情况稳定，选择性盆腔动脉栓塞作为一种保守治疗方法可能是安全有效的选择。这种介入治疗为一种通常采用手术治疗且可能有不可修复并发症风险的疾病提供了一种创新的非手术方法。
