Diagnostic computed tomographic angiography and therapeutic emergency transcatheter arterial embolization for management of postoperative hemorrhage after gynecologic laparoscopic surgery.
OBJECTIVE
To evaluate the diagnostic value of 3-dimensional computed tomographic (CT) angiography and treatment efficacy of emergency transcatheter arterial embolization (TAE) for early postoperative hemorrhage after gynecologic laparoscopic surgery.


METHODS
Retrospective analysis (Canadian Task Force classification II-3).


METHODS
Department of gynecology at a general hospital.


METHODS
Nine patients with early postoperative hemorrhage after gynecologic laparoscopic surgery were treated by TAE between January 2004 and October 2007. Diagnostic 3-dimensional CT angiography was performed for identification of the bleeding artery before TAE in 5 of those patients.


METHODS
Diagnostic 3-dimensional CT angiography and therapeutic emergency TAE.


RESULTS
In all, 2952 patients (1165 laparoscopic-assisted vaginal hysterectomy [LAVH], 1086 adnexal surgery, 417 laparoscopic-assisted myomectomy [LAM], 222 ectopic pregnancy surgery, and 62 other) were treated by laparoscopic surgery between January 1994 and October 2007. Fourteen patients developed postoperative hemorrhagic shock (5 LAVH [0.43%], 1 adnexal surgery [0.09%], 7 LAM [1.68%], 1 ectopic pregnancy surgery [0.45%]). Since 2004, instead of second laparotomy or laparoscopy, TAE was primarily chosen to manage the postoperative hemorrhage for 3 cases after LAVH and 6 cases after LAM. In 5 cases experienced in the last 2 years, diagnostic 3-dimensional CT angiography was performed to identify the bleeding artery before TAE. Transfusion of preoperatively donated autologous blood and intraoperatively salvaged autologous blood was sufficient to maintain vital functions of the patients except in 1 case of LAM that required homologous blood transfusion before TAE as a result of significant delay in establishing the diagnosis. Postembolization course was uneventful except in 1 case of LAVH that developed vaginal stump abscess and required transvaginal drainage twice after readmission.


CONCLUSIONS
Emergency TAE is a safe and effective minimally invasive procedure for patients developing postoperative hemorrhage after gynecologic laparoscopic surgery. Diagnostic CT angiography could play a significant role in shortening the process of TAE by identifying the site of extravasation before TAE.
Takeda
Akihiro
A
Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Gifu, Japan. gyendoscopy@gmail.com
Koyama
Kazuyuki
K
Mori
Masahiko
M
Sakai
Kotaro
K
Mitsui
Takashi
T
Nakamura
Hiromi
H
D000328:Adult; D000792:Angiography; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging* / Q000628:therapy*; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed