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Conservative endovascular management for intractable delayed hemorrhage after laparoscopic-assisted vaginal hysterectomy: Two case reports
Delayed hemorrhage from the vaginal stump is a rare complication following hysterectomy. Most cases can be managed by vaginal packing with or without vaginal vault suturing. However, where such initial management fails, the condition is potentially life-threatening and requires immediate interventio...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9849857/ https://www.ncbi.nlm.nih.gov/pubmed/36683782 http://dx.doi.org/10.1016/j.crwh.2023.e00477 |
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author | Takeda, Akihiro Nakamura, Hiromi Koike, Wataru Nagasaka, Ken |
author_facet | Takeda, Akihiro Nakamura, Hiromi Koike, Wataru Nagasaka, Ken |
author_sort | Takeda, Akihiro |
collection | PubMed |
description | Delayed hemorrhage from the vaginal stump is a rare complication following hysterectomy. Most cases can be managed by vaginal packing with or without vaginal vault suturing. However, where such initial management fails, the condition is potentially life-threatening and requires immediate intervention. We report two cases successfully managed with transcatheter arterial embolization (TAE). First, a 38-year-old woman presented with lower abdominal pain 12 days after laparoscopic-assisted vaginal hysterectomy (LAVH) for a uterine myoma. Oral antibiotics were administered for pelvic infection. Two days later, she experienced increased bleeding. After failing to achieve hemostasis with vaginal vault suturing, computed tomographic angiography showed extravasation from a pseudoaneurysm in the peripheral branch of the left uterine artery. Hemostasis was achieved with TAE. Second, a 40-year-old woman presented with fever and increased abdominal pain 6 days after LAVH for severe dysplasia of the uterine cervix. Intravenous antibiotics were administered for pelvic infection. Twenty-one days after LAVH, she experienced increased bleeding. Computed tomographic angiography showed extravasation from a peripheral thin branch of the right uterine artery. Temporary hemostasis was achieved with vaginal vault suturing; however, bleeding recommenced 12 h later. Hemostasis was achieved with TAE. We conclude that endovascular management is a feasible option for intractable delayed hemorrhage after hysterectomy, when vaginal vault suturing fails to achieve hemostasis. |
format | Online Article Text |
id | pubmed-9849857 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-98498572023-01-20 Conservative endovascular management for intractable delayed hemorrhage after laparoscopic-assisted vaginal hysterectomy: Two case reports Takeda, Akihiro Nakamura, Hiromi Koike, Wataru Nagasaka, Ken Case Rep Womens Health Article Delayed hemorrhage from the vaginal stump is a rare complication following hysterectomy. Most cases can be managed by vaginal packing with or without vaginal vault suturing. However, where such initial management fails, the condition is potentially life-threatening and requires immediate intervention. We report two cases successfully managed with transcatheter arterial embolization (TAE). First, a 38-year-old woman presented with lower abdominal pain 12 days after laparoscopic-assisted vaginal hysterectomy (LAVH) for a uterine myoma. Oral antibiotics were administered for pelvic infection. Two days later, she experienced increased bleeding. After failing to achieve hemostasis with vaginal vault suturing, computed tomographic angiography showed extravasation from a pseudoaneurysm in the peripheral branch of the left uterine artery. Hemostasis was achieved with TAE. Second, a 40-year-old woman presented with fever and increased abdominal pain 6 days after LAVH for severe dysplasia of the uterine cervix. Intravenous antibiotics were administered for pelvic infection. Twenty-one days after LAVH, she experienced increased bleeding. Computed tomographic angiography showed extravasation from a peripheral thin branch of the right uterine artery. Temporary hemostasis was achieved with vaginal vault suturing; however, bleeding recommenced 12 h later. Hemostasis was achieved with TAE. We conclude that endovascular management is a feasible option for intractable delayed hemorrhage after hysterectomy, when vaginal vault suturing fails to achieve hemostasis. Elsevier 2023-01-03 /pmc/articles/PMC9849857/ /pubmed/36683782 http://dx.doi.org/10.1016/j.crwh.2023.e00477 Text en © 2023 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Article Takeda, Akihiro Nakamura, Hiromi Koike, Wataru Nagasaka, Ken Conservative endovascular management for intractable delayed hemorrhage after laparoscopic-assisted vaginal hysterectomy: Two case reports |
title | Conservative endovascular management for intractable delayed hemorrhage after laparoscopic-assisted vaginal hysterectomy: Two case reports |
title_full | Conservative endovascular management for intractable delayed hemorrhage after laparoscopic-assisted vaginal hysterectomy: Two case reports |
title_fullStr | Conservative endovascular management for intractable delayed hemorrhage after laparoscopic-assisted vaginal hysterectomy: Two case reports |
title_full_unstemmed | Conservative endovascular management for intractable delayed hemorrhage after laparoscopic-assisted vaginal hysterectomy: Two case reports |
title_short | Conservative endovascular management for intractable delayed hemorrhage after laparoscopic-assisted vaginal hysterectomy: Two case reports |
title_sort | conservative endovascular management for intractable delayed hemorrhage after laparoscopic-assisted vaginal hysterectomy: two case reports |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9849857/ https://www.ncbi.nlm.nih.gov/pubmed/36683782 http://dx.doi.org/10.1016/j.crwh.2023.e00477 |
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