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Background <p>Uterine artery pseudoaneurysms are rare and potentially fatal postpartum vascular events. Pseudoaneurysms of the uterine artery are rare, and their anomalous origin directly from the infrarenal aorta—rather than the expected internal iliac artery—poses a unique diagnostic and therapeutic challenge. We present a case where distorted vascular anatomy, compounded by self-inflicted trauma in a psychotic postpartum state, led to a catastrophic retroperitoneal haemorrhage.</p> Case Presentation <p>A 28-year-old unregistered grand multipara (G6P4L4A1) with severe iron-deficiency anaemia (Hb 5.7&#xa0;g/dL) delivered vaginally at 34.3&#xa0;weeks. On postpartum day 2, she developed acute psychosis with self-harming behaviour, striking her abdomen with a stone. This was followed by abdominal distension and signs of haemorrhagic shock. CECT imaging revealed bilateral pseudoaneurysms of uterine arteries—misidentified initially as ovarian artery pseudoaneurysms—originating anomalously from the infrarenal aorta, with rupture of the left-sided lesion and a large retroperitoneal hematoma (450–500&#xa0;cc) extending into perinephric spaces.</p> Intervention and Outcome <p>Prompt endovascular intervention of bilateral uterine arteries with polyvinyl alcohol (PVA) particle and glue embolization, along with infrarenal aortic stent grafting, successfully excluded the pseudoaneurysms and controlled the haemorrhage. Postoperative recovery was complicated by post-embolization syndrome and hypokalaemia but was managed successfully. Serial imaging confirmed gradual resolution of the hematoma. Differentiation between intra- and retroperitoneal haemorrhage was crucial for appropriate surgical planning and vascular access strategy.</p> Conclusion <p>This case underscores the critical need for early psychiatric vigilance and to be mindful of the possibility of anomalous origin of vascular anatomy. In postpartum haemorrhage cases involving anomalous vascular anatomy, prompt imaging and endovascular management are required for timely management of concealed haemorrhage.</p>

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Anomalous Aortic Origin of Bilateral Uterine Arteries Presenting as Catastrophic Ruptured Pseudoaneurysms in the Postpartum Period

  • 期刊论文

  • 发表日期：

    2025年9月25日

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  • Preeti F. Lewis,
  • Shruti B. Ranjanagi,
  • Dishant Upadhyay

摘要

Background

Uterine artery pseudoaneurysms are rare and potentially fatal postpartum vascular events. Pseudoaneurysms of the uterine artery are rare, and their anomalous origin directly from the infrarenal aorta—rather than the expected internal iliac artery—poses a unique diagnostic and therapeutic challenge. We present a case where distorted vascular anatomy, compounded by self-inflicted trauma in a psychotic postpartum state, led to a catastrophic retroperitoneal haemorrhage.

Case Presentation

A 28-year-old unregistered grand multipara (G6P4L4A1) with severe iron-deficiency anaemia (Hb 5.7 g/dL) delivered vaginally at 34.3 weeks. On postpartum day 2, she developed acute psychosis with self-harming behaviour, striking her abdomen with a stone. This was followed by abdominal distension and signs of haemorrhagic shock. CECT imaging revealed bilateral pseudoaneurysms of uterine arteries—misidentified initially as ovarian artery pseudoaneurysms—originating anomalously from the infrarenal aorta, with rupture of the left-sided lesion and a large retroperitoneal hematoma (450–500 cc) extending into perinephric spaces.

Intervention and Outcome

Prompt endovascular intervention of bilateral uterine arteries with polyvinyl alcohol (PVA) particle and glue embolization, along with infrarenal aortic stent grafting, successfully excluded the pseudoaneurysms and controlled the haemorrhage. Postoperative recovery was complicated by post-embolization syndrome and hypokalaemia but was managed successfully. Serial imaging confirmed gradual resolution of the hematoma. Differentiation between intra- and retroperitoneal haemorrhage was crucial for appropriate surgical planning and vascular access strategy.

Conclusion

This case underscores the critical need for early psychiatric vigilance and to be mindful of the possibility of anomalous origin of vascular anatomy. In postpartum haemorrhage cases involving anomalous vascular anatomy, prompt imaging and endovascular management are required for timely management of concealed haemorrhage.