Postpartum Aortic-Origin Uterine Artery Pseudoaneurysm: Retroperitoneal Hematoma Treated With Coils

We report a rare case of massive left abdominopelvic hematoma (~16.6 × 13.9 × 14.5 cm) from a 1.3 cm pseudoaneurysm on an aberrant uterine artery from the anterior abdominal aorta, arising between the superior mesenteric artery and inferior mesenteric artery, supplying the lateral uterus in a woman in the postpartum period. The hematoma manifested on postpartum day two with signs of hypovolemia and a painful, throbbing lump in the left lower abdomen. Computed tomography (CT) angiography revealed a large retroperitoneal hematoma and a pseudoaneurysm associated with the anomalous artery, which also showed an aorta of normal caliber and no abdominal aortic aneurysm. Successful hemostasis was achieved using selective endovascular coil embolization with adjunct Gelfoam (Pfizer Inc., New York, United States). This case emphasizes vigilance for vascular anomalies in postpartum hemorrhage and demonstrates how advanced imaging and rapid endovascular intervention can prevent maternal morbidity and mortality.