Temporary bilateral uterine artery occlusion in the control of hemorrhage: A case report and review of literature

Abstract

Background: Intramural pregnancy is rare, with an unclear etiology and pathophysiology. Surgical, medical, and expectant management options are available for this condition. However, most reported cases are managed surgically. Despite the risks of massive intraoperative bleeding and acute and long-term complications, uterine artery embolization is often selected. Temporary occlusion of the bilateral uterine arteries during surgery is associated with fewer complications.

Case summary: We reported the case of a patient who was diagnosed with intramural pregnancy approximately one month after medical abortion. We performed laparoscopic resection with hysteroscopy. Since the lesion had abundant blood flow, we temporarily blocked the bilateral uterine arteries to prevent massive intraoperative bleeding. The surgical process went smoothly. The postoperative course was uneventful.

Conclusion: Temporary occlusion of the bilateral uterine arteries in the treatment of intramural pregnancy may prevent excessive uterine bleeding during surgery.

Keywords: Case report; Hysteroscopy; Intramural pregnancy; Laparoscopic surgery; Uterine artery temporary occlusion.

Figure 1

Imaging examinations. A: Color Doppler ultrasound image showing abundant blood flow around it (the "ring of fire" sign); B: Pelvic magnetic resonance imaging showed a nodular measuring approximately 1.5 cm within the myometrium in the left wall of the uterus.

Figure 2

Surgical images. A: Hysteroscopy showing no apparent pregnant tissue but rather a membrane-like substance measuring approximately 1 cm × 1 cm near the left uterine horn; B: We cut the serous membrane layer near the left uterine corner approximately 2 cm deep, where villous tissue measuring approximately 1 cm in diameter was visible; C: The uterine artery was occluded with titanium clamps.