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[Severe blood loss days after suction and curettage: consider a pseudoaneurysm].

BACKGROUND
A pseudo-aneurysm of the arteria uterina is a rare cause of hemorrhage after gynaecological surgery. Usually there is an interval of a few days to weeks between the inciting factor and the blood loss. The often late diagnosis can lead to a life-threatening hemorrhage. Correct diagnosis is necessary because a therapeutic curettage may worsen the blood loss. On ultrasound a pseudo-aneurysm can be suspected by the typical image of a anechogenicity with varying turbulent flow on doppler ultrasound. The gold standard for treatment is a arterial embolization that is minimal invasive, has a high success rate and can store the fertility.


CASE DESCRIPTION
A 32-year old woman underwent a curettage because of an incomplete miscarriage. Nine days after surgery the blood loss increased. A pseudo-aneurysm was diagnosed and treated successfully by an embolization of the right uterine artery.


CONCLUSION
Hemorrhage is the most common complication of a curettage. Delayed blood loss after curettage can be caused by a pseudo-aneurysm. In literature there are mostly case reports of pseudo-aneurysms as a cause of a late postpartum haemorrhage after a caesarean section. Arterial embolization is the gold standard for the treatment of a pseudo-aneurysm with a high success rate and conservation of fertility. The advantage is that diagnosis and treatment can happen at once, so there is no time lost. The indication for curettage should be made correctly given the possible adverse effects.