Fatal Hemorrhagic Shock From Rupture of a Giant Uterine Artery Pseudoaneurysm 20 Years After Myomectomy: A Case Successfully Managed With Transcatheter Arterial Embolization

A uterine artery pseudoaneurysm (UAP) is a rare and serious complication after gynecological surgery, and its rupture can cause fatal bleeding. In this report, a rare case of UAP rupture 20 years after myomectomy is presented, along with a discussion of the diagnosis and treatment strategy. A 54-year-old woman had undergone open hysterectomy for cervical myoma 20 years earlier. She was brought to the emergency room with sudden lumbar back pain and loss of consciousness and was diagnosed with a ruptured pseudoaneurysm of the right uterine artery by contrast-enhanced computed tomography and angiography. Transcatheter arterial embolization was performed, and her vitals were stabilized. Subsequent magnetic resonance imaging showed a pseudoaneurysm after a contained rupture that had become organic, and a portion of the nonorganized component remained. Six months later, a partial resection was performed by laparotomy. This case indicates the need for long-term postoperative follow-up and is reported here for comparison with previous reports.