ro13-9904 and Aneurysm--False

Topics: Aged; Aneurysm, False; Aneurysm, Infected; Anti-Bacterial Agents; Blood; Ceftriaxone; Humans; Male; Pelvis; Radiography, Abdominal; Salmonella enteritidis; Salmonella Infections; Tomography, X-Ray Computed; Treatment Outcome; Urine

We report an exceptional case of secondary postpartum hemorrhage (PPH) twenty days after cesarean delivery, resulting from a ruptured uterine artery pseudoaneurysm (UAP). The diagnosis was initially confounded by a septic shock necessitating inotropic support in the intensive care unit. Intense vaginal bleeding occurred eleven days after uterine curettage. Doppler ultrasound showed an anechoic focus in the inferior part of the uterus with turbulent flow. Bilateral internal iliac artery angiograms revealed a left uterine artery pseudoaneurysm that was successfully embolized. UAP is a rare cause of unexplained PPH that requires a high index of suspicion for diagnosis. This first report in the anesthesia literature serves to focus our awareness on its possible occurrence, and gives track to its management. Pitfalls in UAP diagnostic are highlighted (delayed presentation, possibility of spontaneous hemostasis, and lack of typical findings on colour Doppler sonography in hypotensive patients). These pitfalls may further be confounded by a concomitant sepsis. Angiography and selective uterine artery embolization is the treatment of choice.

Topics: Aneurysm, False; Aneurysm, Ruptured; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Cesarean Section; Female; Follow-Up Studies; Humans; Metronidazole; Postpartum Hemorrhage; Pregnancy; Radiography; Shock, Septic; Treatment Outcome; Ultrasonography, Doppler; Uterine Artery; Uterine Artery Embolization

Topics: Aged; Aneurysm, False; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Thoracic; Ceftriaxone; Humans; Male; Salmonella enteritidis; Salmonella Infections

Topics: Aneurysm, False; Aneurysm, Infected; Aortic Aneurysm, Thoracic; Ceftriaxone; Cephalosporins; Humans; Magnetic Resonance Angiography; Male; Middle Aged