Obstetrics and Gynaecology Cases - Reviews Case report: Open Access ClinMed International Library Citation: Gabbi L, Petrocelli F, Di Domenico S, Ferrero S, Remorgida V (2014) Conservative Management of Uterine Artery Pseudoaneurysm Rupture with Rectal Fistula after Laparoscopic Myomectomy and Review of the Literature. Gynecol Cases Rev 1:019 Received: November 17, 2014: Accepted: December 14, 2014: Published: December 17, 2014 Copyright: © 2014 Gabbi L. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Gabbi et al. Obstet Gynecol cases Rev 2014, 1:3 ISSN: 2377-9004 Conservative Management of Uterine Artery Pseudoaneurysm Rupture with Rectal Fistula after Laparoscopic Myomectomy and Review of the Literature Gabbi L 1 , Petrocelli F 2 , Di Domenico S 3 , Ferrero S 1 and RemorgidaV 1 1 Department of Obstetric and Gynaecology, IRCCS San Martino-IST and University of Genoa, Italy 2 Department of Diagnostic and Interventional Radiology, IRCCS San Martino-IST and University of Genoa, Italy 3 Department of General Surgery, IRCCS San Martino-IST and University of Genoa, Italy *Corresponding author: Laura Gabbi MD, Department of Obstetrics and Gynaecology, IRCCS San Martino-IST and University of Genoa, L.go Rosanna Benzi, 1 Pad 1 16131 Genova, Italy, Tel: 0105557723; Fax: 0105556714; E-mail: gabbi2@libero.it diference with true aneurysm. Te incidence of pseudoaneurysm formation is not well known because it can be silent, the delay of symptoms if rupture occurs [1] and the diagnosis is not easy. Tis event can be life-threatening if rupture happens. Isono [2] found that the interval between surgery and pseudoaneurysm rupture can vary between 3 to 60 days. Te main symptoms of rupture are methrorrhagia, abdominal pain and anemia. Diagnosis can be made with Ultrasonography (US), Color Doppler Ultrasonography (CDUS), Computer Tomography (CT), Magnetic Resonance Imaging (MRI) and angiography. Te gold standard for treatment is transfemoral angiography with concomitant embolisation. We report a case of pseudoaneurysm rupture associated with bleeding from the rectum and conservative management along with a review of literature. A PubMed search of English literature was performed using: “uterine artery pseudoaneurysm” and “uterine artery pseudoaneurysm and rectal bleeding” .We found 106 articles, 105 for the frst search and only one for the second. Te latter refers to a case of locally advanced cervical [3]. In our knowledge our case should be the frst of a ruptured UAP, afer laparoscopic myomectomy, associated with proctorrhagia. Case Report A 43 years old nulliparous woman with sudden abdominal pain associated with rectal bleeding came to our attention in April 2013. A gasless laparoscopic myomectomy had been performed one month before (in another hospital) for the removal of an 8 cm intramural leyomioma, located on the posterior wall, causing severe methrorrhagia. Although procthorrhagia was not massive her hemoglobin concentration at admission was 10,4g/l, dropping to 8,4g/l afer 3 hours. Leucocytosis was also present. She immediately underwent a CT scan showing the presence of a dyshomogenous mass behind the uterus of 10x7x8cm with a central hypodensepart Abstract Late uterine hemorrhage caused by uterine artery pseudoaneurysm is a rare but life-threatening complication after uterine surgery. The association of uterine pseudoanerysm rupture causing rectal fstula has not been reported in literature as well as its management. Herein we report a case of massive late uterine bleeding and rectal bleeding after laparoscopic myomectomy. A 43 year old Caucasian nulliparous woman underwent laparoscopic excision of 8 cm posterior intramural myoma. One month later she developed acute abdominal pain and proctorrhagia. A Computer Tomography scan (CT) demonstrated a 10 cm pelvic hematoma. The transvaginal ultrasound (TVU) showed 1 cm aneurism of the uterine artery. Transarterial angiography confrmed the ruptured uterine artery pseudoaneurysm that was successfully embolized. Repeated colonoscopy showed a rectal fstula. Total parenteral nutrition (TPN) and antibiotic prophylaxis were started. During the following month the intensity and frequency of proctorrhagia gradually declined. After four week of TPN colonoscopy confrmed a complete fstula healing. Oral feeding was gradually reintroduced. Two months later an ultrasound scan showed a complete resolution of the pelvic hematoma. To the best of our knowledge this the frst described association of two rare complications: a pseudoaneurysm rupture and the subsequent rectal laceration successfully treated with embolization and conservative management. Keywords Uterine artery pseudoaneurysm, Rectal bleeding, Rectal fstula, Myomectomy Introduction Pseudoaneurysm of uterine artery (UAP) is a rare complication afer gynecological, obstetric and pelvic surgery. Pseudoaneurysm is characterized by the absence of the three layers in its boundaries and by the presence of a peripheral thrombus [1] and this is the main