Ectopic Vaginal Varices With Hemorrhage After Hysterectomy

Abstract

Vaginal and uterine varices are well documented in pregnancy, although development of vaginal varices in patients with portal hypertension occurs in an exceptionally rare subset. Only 12 cases are reported in the literature; all but 3 of these cases involved patients with a history of hysterectomy, with 1 of the remaining 2 exhibiting partial obliteration of the uterine plexus due to radiation therapy for cervical cancer. We present a case of recurrent vaginal variceal bleeding in a patient with a history of hysterectomy, initially managed with vaginal tamponade and ultimately requiring definitive treatment with transjugular intrahepatic portosystemic shunt insertion.

Figure 1.

Pelvic ultrasound image demonstrating large varices at the vaginal cuff; the patient previously underwent hysterectomy.

Figure 2.

Venogram performed through transhepatic access identifying inferior mesenteric vein branch with large vaginal cuff varices. Note metallic coils from previous coil embolization of varices 2 years prior.