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Transvaginal oocyte retrieval complicated by life-threatening obturator artery haemorrhage and managed by a vessel-preserving technique.

Bolster F, Mocanu E, Geoghegan T, Lawler L - Ulster Med J (2014)

Bottom Line: Four days following the procedure she presented with life threatening haemorrhagic shock.She underwent surgical laparotomy followed by CT and selective angiography, which demonstrated haemorrhage from a pseudoaneurysm of the obturator artery.The haemorrhage was successfully managed endovascularly with a vessel preserving covered stent.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Mater Misericordiae University Hospital Dublin, Ireland.

ABSTRACT
We report the case of a 36-year-old woman with secondary infertility who underwent routine transvaginal oocyte retrieval as part of IVF treatment. Four days following the procedure she presented with life threatening haemorrhagic shock. She underwent surgical laparotomy followed by CT and selective angiography, which demonstrated haemorrhage from a pseudoaneurysm of the obturator artery. The haemorrhage was successfully managed endovascularly with a vessel preserving covered stent.

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CTA demonstrates a vascular “blush” of a 2cm pseudoaneurysm and active extravasation from a branch of the right internal iliac artery (white arrow).
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fig02: CTA demonstrates a vascular “blush” of a 2cm pseudoaneurysm and active extravasation from a branch of the right internal iliac artery (white arrow).

Mentions: A 36-year-old female with secondary infertility underwent ultrasound-guided transvaginal oocyte retrieval during her third IVF cycle. Postoperative discomfort persisted for longer than usual and she was admitted for observation. As she had persistent right sided back discomfort she remained in hospital while undergoing investigations. On the fourth day she developed light headedness and collapsed. The patient was resuscitated and underwent emergency laparotomy, which revealed a large right sided retroperitoneal haematoma. No further surgical exploration was pursued as no intraperitoneal bleeding was observed and because of the risk of severe bleeding associated with decompressing. She was transfused and haemodynamically stabilised with 5 units of packed red cells, 3 pools of plasma (Octaplase) and 2 pools of platelets and referred for radiological management. CT angiography (CTA) of abdomen and pelvis demonstrated active bleeding from a right internal iliac artery branch pseudoaneurysm and a large retroperitoneal haemorrhage (Figs 1 and 2). She was transferred directly to the angiography suite for emergency endovascular assessment and therapy.


Transvaginal oocyte retrieval complicated by life-threatening obturator artery haemorrhage and managed by a vessel-preserving technique.

Bolster F, Mocanu E, Geoghegan T, Lawler L - Ulster Med J (2014)

CTA demonstrates a vascular “blush” of a 2cm pseudoaneurysm and active extravasation from a branch of the right internal iliac artery (white arrow).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4255834&req=5

fig02: CTA demonstrates a vascular “blush” of a 2cm pseudoaneurysm and active extravasation from a branch of the right internal iliac artery (white arrow).
Mentions: A 36-year-old female with secondary infertility underwent ultrasound-guided transvaginal oocyte retrieval during her third IVF cycle. Postoperative discomfort persisted for longer than usual and she was admitted for observation. As she had persistent right sided back discomfort she remained in hospital while undergoing investigations. On the fourth day she developed light headedness and collapsed. The patient was resuscitated and underwent emergency laparotomy, which revealed a large right sided retroperitoneal haematoma. No further surgical exploration was pursued as no intraperitoneal bleeding was observed and because of the risk of severe bleeding associated with decompressing. She was transfused and haemodynamically stabilised with 5 units of packed red cells, 3 pools of plasma (Octaplase) and 2 pools of platelets and referred for radiological management. CT angiography (CTA) of abdomen and pelvis demonstrated active bleeding from a right internal iliac artery branch pseudoaneurysm and a large retroperitoneal haemorrhage (Figs 1 and 2). She was transferred directly to the angiography suite for emergency endovascular assessment and therapy.

Bottom Line: Four days following the procedure she presented with life threatening haemorrhagic shock.She underwent surgical laparotomy followed by CT and selective angiography, which demonstrated haemorrhage from a pseudoaneurysm of the obturator artery.The haemorrhage was successfully managed endovascularly with a vessel preserving covered stent.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Mater Misericordiae University Hospital Dublin, Ireland.

ABSTRACT
We report the case of a 36-year-old woman with secondary infertility who underwent routine transvaginal oocyte retrieval as part of IVF treatment. Four days following the procedure she presented with life threatening haemorrhagic shock. She underwent surgical laparotomy followed by CT and selective angiography, which demonstrated haemorrhage from a pseudoaneurysm of the obturator artery. The haemorrhage was successfully managed endovascularly with a vessel preserving covered stent.

Show MeSH
Related in: MedlinePlus