title: Spontaneous retroperitoneal hemorrhage caused by rupture of an ovarian artery aneurysm: a case report and review of the literature.
abstract: BACKGROUND
  Spontaneous rupture of an ovarian artery aneurysm is extremely rare. Although a majority of these cases have been associated with pregnancy, there have been recent reports and reviews of rare cases that were not directly associated with pregnancy. Transcatheter arterial embolization is considered to be an alternative therapy to surgery.
  
  
  METHODS
  A 44-year-old Japanese woman, gravida 3 para 3, presented to our emergency room complaining of intermittent right flank pain. She had undergone a cesarean section 2 years previously, and had no history of abdominal trauma. On admission, her blood pressure was 115/78 mmHg, pulse 70 beats per minute, and hemoglobin concentration 9.8 g/dL. Abdominal ultrasonography and contrast-enhanced dynamic computed tomography revealed a large retroperitoneal hematoma. Findings on three-dimensional computed tomography angiography suggested ruptured aneurysm of her right ovarian artery. A selective right ovarian artery angiogram revealed a tortuous aneurysm. Transcatheter arterial embolization using N-butyl-2-cyanoacrylate was performed. The aneurysm was successfully embolized, and her course after embolization was uneventful. She has remained symptom-free during 3 months of follow-up.
  
  
  CONCLUSIONS
  This was a very rare case of a patient who had a retroperitoneal hemorrhage originating from an ovarian artery aneurysm. A review of published case reports found that contrast-enhanced computed tomography with reconstruction images is an excellent imaging tool. Diagnostic angiography and subsequent transcatheter arterial embolization are thought to be very effective for this condition.
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. m-toyo@med.tohoku.ac.jp.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Toyoshima
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. zipperxxxty@snh.go.jp.
authors.forename: Takako
authors.initials: T
authors.lastname: Kudo
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. fuji3-saorin5@herb.ocn.ne.jp.
authors.forename: Saori
authors.initials: S
authors.lastname: Igeta
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. hmakino@snh.go.jp.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Makino
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. my_5amm1320@yahoo.co.jp.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Momono
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. tshima@snh.go.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Shima
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. rui_s@tim.hi-ho.ne.jp.
authors.forename: Rui
authors.initials: R
authors.lastname: Matsuura
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. ishigaki@snh.go.jp.
authors.forename: Nobuko
authors.initials: N
authors.lastname: Ishigaki
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. akagik@snh.go.jp.
authors.forename: Kozo
authors.initials: K
authors.lastname: Akagi
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. takeyama@sendai.jrc.or.jp.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Takeyama
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. soredemokitamichi1119@yahoo.co.jp.|Department of Obstetrics and Gynecology, Self-Defense Force Sendai Hospital, Sendai, Japan. soredemokitamichi1119@yahoo.co.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Iwahashi
authors.affiliation: Department of Radiology, Sendai Medical Center, National Hospital Organization, Sendai, Japan. rikimaru@snh.go.jp.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Rikimaru
authors.affiliation: Department of Radiology, Sendai Medical Center, National Hospital Organization, Sendai, Japan. satoa@snh.go.jp.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sato
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. y-kou-m@mtb.biglobe.ne.jp.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Yoshinaga
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000628:therapy; D000792:Angiography; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D003287:Contrast Media; D004621:Embolization, Therapeutic; D005260:Female; D021501:Flank Pain / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D010053:Ovary / Q000098:blood supply*; D012422:Rupture, Spontaneous
chemical_list: D003287:Contrast Media