Severe delayed postpartum hemorrhage due to a neglected uterine diverticulum: a case report.
BACKGROUND
Symptomatic uterine diverticula are rare and, to our knowledge, have never been reported as a cause of postpartum hemorrhage.


METHODS
A 35-year-old woman presented with severe vaginal bleeding on the 47th day after a cesarean section. She had received endometrial curettage due to postpartum hemorrhage a few days earlier in another local hospital. Transvaginal ultrasound revealed a thickened heteroechoic endometrium and an isolated isthmic heteroechoic cystic lesion. Repeat endometriaI curettage was performed initially. However, recurrent vaginal bleeding and hypovolemic shock occurred 2 days later. Active bleeding from a debris-full diverticulum in the lateral wall of the uterine isthmus was found during an emergent hysterotomy. The myometrium was sutured to obliterate the diverticulum. The follow-up course was uneventful.


CONCLUSIONS
Uterine diverticula may present as isolated isthmic heteroechoic cystic lesions and may be overlooked as a cause of severe delayed postpartum hemorrhage.
Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan.
Mei-Chu
MC
Wu
Yao-Peng
YP
Hsu
Ho-Hsiung
HH
Lin
Sheng-Mou
SM
Hsiao
D000328:Adult; D017604:Cesarean Section, Repeat / Q000009:adverse effects; D004240:Diverticulum / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D020883:Hysterotomy; D006473:Postpartum Hemorrhage / Q000175:diagnosis* / Q000209:etiology*; D011247:Pregnancy; D012769:Shock / Q000175:diagnosis / Q000209:etiology; D014591:Uterine Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery