Postpartum Left Ovarian Artery Aneurysms 

                                                                                        Rasha Mohamed Ali Homida

                                                                                                 Fiona Hendry

                                                                                                  Mona Salih

                                                                            Queen Elizabeth University Hospital -Glasgow

 

 

 

Objective:

 Spontaneous rupture of an ovarian artery aneurysm during puerperium is extremely rare and life-threatening condition. It is asymptomatic, likely underdiagnosed and understudied. {1,2}

During the normal process of  involution that occurs  after delivery , a segment of the ovarian circulation may fail to involute causing Aneurysm .{3}

The common presentation of spontaneous rupture of an ovarian artery aneurysm is abdominal pain in a multiparous woman during the early postpartum period and the probable time of rupture can be traced to the second stage of labor due to intense pushing.{4}

 A high index of suspicion, prompt diagnosis, intervention, and a multidisciplinary approach in the management, were the elements of a successful outcome in this case.{4]

 

Case summary

  A 45 years old Para 8 lady ,13 days postnatal presented with a sudden onset sharp dull left side abdominal pain, radiated to groin and unresponsive to simple analgesia. There is a minimal PV bleeding,  Her notes revealed frequent presentation to the Emergency with the same pain .

Abdominal examination was unremarkable apart from slight left side abdominal tenderness.

The CT and angiographic imaging showed two aneurysms of the left ovarian artery. The first was presumed to have ruptured in the postpartum period causing a retroperitoneal hematoma(15 x 9 cm in diameter). The second aneurysm was close to the ovarian artery origin and appears intact measuring (9 mm.). Both aneurysms were embolized. with multiple coils, and CT Angiogram showed satisfactory occlusion.

 

 Discussion:

 Available reports are suggesting multiparity is a risk factor for rupture of an ovarian artery aneurysm.

 In earlier reports, rupture aneurysm was diagnosed mostly by exploratory laparotomy because most of the patient were presented with severe bleeding and unstable observations. However, our lady was hemodynamically stable and diagnosed by a CT Angiogram and treated by interventional radiology .

 According to previously published literature, most of the spontaneous rupture of an ovarian artery aneurysm requires immediate management because they were accompanied by massive.

 

 Conclusion:

 This is one of the rarest case of spontaneous rupture of an ovarian artery aneurysm as our patient presented with a vague abdominal pain and diagnosed with Angiography followed by  TAE (Transcatheter arterial embolization) ,showing that it could be an effective therapeutic procedure for such an event.

Any postpartum woman with a vague presentation to the emergency department should always be considered.

 

 

References:

1-Caillouette JC, Owen HW. Postpartum spontaneous rupture of an ovarian-artery aneurysm. Obstet Gynecol. 1963;21:510–1.

CAS PubMed Google Scholar

2-Weedin, Elizabeth A. DO; Mercer, Laura T. MD; Wood, David L. MD; Baker, Edmond MD.Ovarian artery aneurysm after postpartum Haemorrhage {2}

3-1. Burnett RA, Carfrae DC. Spontaneous rupture of ovarian artery aneurysm in the puerperium. Two case reports and a review of the literature. Br J Obstet Gynaecol. 1976;83:744–750. doi: 10.1111/j.1471-0528.1976.tb00926.x. [PubMed] [CrossRef] [Google Scholar]

4-Christopher A. Enakpene, Toni Stern, Marco J. Barzallo Salazar, Pradip Mukherjee, "Spontaneous Rupture of an Ovarian Artery Aneurysm: A Rare Postpartum Complication", Case Reports in Obstetrics and Gynecology, vol. 2016, Article ID 1029561, 4 pages, 2016. https://doi.org/10.1155/2016/1029561