Xie JP, Chen LL, Lv W, Li W, Fang H, Zhu G. Emergency internal iliac artery temporary occlusion after massive hemorrhage during surgery of cesarean scar pregnancy: A case report. World J Clin Cases 2023; 11(17): 4065-4071 [PMID: 37388788 DOI: 10.12998/wjcc.v11.i17.4065]
Corresponding Author of This Article
Guang Zhu, MM, Department of Gynecology, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou 310012, Zhejiang Province, China. zhuguang6603131@163.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ji-Ping Xie, Lin-Lin Chen, Wen Lv, Wu Li, Guang Zhu, Department of Gynecology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
Hui Fang, Department of Medical Ultrasonics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
Author contributions: Xie JP reviewed the literature and contributed to manuscript drafting; Chen LL involved in the data curation; Lv W supervised the findings of this work; Li W did the surgical appraisal; Fang H analyzed and interpreted the imaging findings; Zhu G was responsible for the revision of the manuscript for important intellectual content; and all authors issued final approval for the version to be submitted.
Supported byMedical Health Science and Technology Project of Zhejiang Province, China, No. 2020ZH003.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guang Zhu, MM, Department of Gynecology, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou 310012, Zhejiang Province, China. zhuguang6603131@163.com
Received: December 27, 2022 Peer-review started: December 27, 2022 First decision: March 24, 2023 Revised: April 24, 2023 Accepted: May 19, 2023 Article in press: May 19, 2023 Published online: June 16, 2023 Processing time: 167 Days and 1.5 Hours
Abstract
BACKGROUND
Cesarean scar pregnancy (CSP) is rare but may result in uterine rupture during pregnancy or massive hemorrhage during abortion procedures. Awareness of this condition is increasing, and most patients with CSP are now diagnosed early and can be managed safely. However, some atypical patients are misdiagnosed, and their surgical risks are underestimated, increasing the risk of fatal hemorrhage.
CASE SUMMARY
A 27-year-old Asian woman visited our institution because of abnormal pregnancy, and she was diagnosed with a hydatidiform mole through trans-vaginal ultrasound (TVS). Under hysteroscopy, a large amount of placental tissue was found in the scar of the lower uterine segment, and a sudden massive hemorrhage occurred during the removal process. The bilateral internal iliac arteries were temporarily blocked under laparoscopy, and scar resection and repair were rapidly performed. She was discharged in good condition 5 d after the operation.
CONCLUSION
Although TVS is widely used in the diagnosis of CSP, delays in the diagnosis of atypical CSP remain. Surgical treatment following internal iliac artery temporary occlusion may be an appropriate management method for unanticipated massive hemorrhage during CSP surgery.
Core Tip: Unanticipated massive hemorrhage during cesarean scar pregnancy surgery can lead to serious complications. If not effectively managed, it can lead to hemorrhagic shock or even death. Uterine artery embolization is usually used to prevent massive hemorrhage, but it requires multidisciplinary cooperation and cannot be performed immediately in the case of emergency. We adopted bilateral internal iliac artery emergency temporary occlusion to control intraoperative bleeding immediately without postoperative complications, and this may be a feasible method.
