A Case of Concomitant Inferior Epigastric Artery Injury and Superior Vesical Artery Pseudoaneurysm after Cesarean Section Treated with Transarterial and Transvaginal Embolization

Hemorrhagic complications following cesarean section, including rectus sheath hematoma and bladder flap hematoma, are uncommon but potentially life threatening. We describe a rare case of concurrent inferior epigastric artery injury and superior vesical artery pseudoaneurysm after cesarean delivery in a 27-year-old woman with a prior cesarean section. Despite laparotomy, hemostasis was not achieved, and she required massive transfusion. Transarterial embolization successfully controlled inferior epigastric artery bleeding, but tortuosity and collateral circulation limited embolization of the superior vesical artery pseudoaneurysm. Subsequent transvaginal ultrasound-guided direct puncture with injection of a mixture of n-butyl-2-cyanoacrylate and Lipiodol resulted in hemostasis. The patient recovered without rebleeding. This case underscores the importance of considering rare vascular complications after cesarean section and demonstrates transvaginal ultrasound-guided puncture as a valuable alternative when conventional methods fail.