Resection of a vulvar arteriovenous malformation in a premenarchal patient.
BACKGROUND
Arteriovenous malformation of the vulva is described in only a few case reports in the literature. Given the complex anatomy of the vulva, arteriovenous malformations in this location present a particularly challenging treatment dilemma.


METHODS
An 11-year-old premenarchal girl with a large vulvar arteriovenous malformation was monitored for several years. After three episodes of bleeding, despite conservative management with embolization, she was taken urgently to the operating room for resection of the lesion. A multidisciplinary team participated in the 12-hour procedure. Several months after the initial surgery, the patient is without complaints and adjusting well. Labial reduction will be required once she is fully grown.


CONCLUSIONS
Arteriovenous malformations of the vulva require treatment before the onset of menarche because of the potential for massive hemorrhage. If first-line conservative treatment with embolization fails, a multidisciplinary team should be assembled for surgical treatment.
Brotherton
Joy
J
From the Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California; and the Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, California.
Yazdany
Tajnoos
T
D001165:Arteriovenous Malformations / Q000601:surgery*; D002648:Child; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008572:Menarche; D016038:Skin Transplantation; D014844:Vulva / Q000098:blood supply*; D014845:Vulvar Diseases / Q000601:surgery*