Spontaneous Uterine Artery Rupture in a Nongravid Patient

A 35-year-old patient presented with sudden onset, severe, lower abdominal pain, hemodynamic instability, a greater than forty-point decrease in hemoglobin, negative pregnancy test, and a CT scan indicating possible ruptured hemorrhagic cyst. A diagnostic laparoscopy was performed revealing significant hemoperitoneum approximating two litres and a ruptured left uterine artery (image 1). The left broad ligament was dissected and bipolar energy was used to ligate and secure the left uterine artery both distally and proximally (image 2). The pelvic anatomy was otherwise normal, there was no evidence of infection, endometriosis, iatrogenic injury or other pathology. The patient was otherwise healthy and their only surgical history was two cesarean sections. The uterine artery rupture etiology is unclear but we hypothesize that it may have been due to a vessel malformation at the site or an element of connective tissue disorder due to no other risk factors identified. The post-operative course was uneventful and the patient was discharged home on day two. Spontaneous rupture of the uterine artery is an incredibly rare event, and even more rare to occur outside of pregnancy or the puerperium period. Four other cases were noted in the literature, two seemingly due to IUD removal1,2 and two with unknown causes.3,4 This patient's management was unique in that we used laparoscopy for diagnosis and management. Previously, similar cases have been managed with laparotomy or uterine artery embolization. As minimally invasive gynecologic surgery continues to expand, future similar cases can be approached laparoscopically if the managing surgeon feels it is an appropriate choice. A minimally invasive approach would provide benefit to the patient in terms of post-operative recovery and to the health system with less time required for inpatient management during the post-operative recovery period.Image 2Laparoscopic view achieving hemostasis of the posterior aspect of the pelvis showing dissection of the left broad ligament and the internal diameter of the left uterine artery.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Dr. Smith has received honorarium for teaching from Organon Canada. approval not required. written consent obtained. No acknowledgements No disclosures 1.Yu X, Guan J, Sun T. Uterine artery rupture after induced abortion and extraction of an intrauterine device. Chinese Medical Journal. 2016 Feb 20;129(4):484-486.2.Wang N, Sun H. Uterine artery rupture caused by IUD extraction: a case report. Internal Journal of Women's Health. 2022 June 27;14:831-836.3.Nathan J, Yen V, Ab Manan N. Spontaneous uterine artery rupture in a non-pregnant woman: A case report. Journal of Emergency Practice and Trauma. 2023 Feb 14;9(1)4.Rabie M, Wali M. Spontaneous rupture of the uterine artery in a non-pregnant woman. Annals of Saudi Medicine. 2003 May 1;23(3):177-78.