Abstract:

A case of the two lesions of uterine arteriovenous fistula combined with retained products of conception was reported. The patient was admitted to hospital with vaginal dripping bleeding with paroxysmal massive bleeding after the curettage of missed miscarriage. Uterine artery embolization was performed after admission. Uterine arteriovenous fistula was definitely diagnosed during the operation. On the second day, hysteroscopy combined with laparoscopy was performed. Hysteroscopy revealed that the embryo residues in the uterine cavity. Laparoscopy revealed that the right cornu uteri protrusion, while the left fundus near the left cornu uteri was locally purple blue lesions. The surface was covered with a large number of malformed blood vessels. During laparoscopic resection of the right cornu uteri and the left fundus lesions, tubular dilated blood vessels between the muscular layers was observed. Uterine arteriovenous fistula appeared a fatal hemorrhage, when combined with embryo residue, the risk of bleeding was higher. Clinical awareness of uterine arteriovenous fistula combined with retained products of conception needs to be improved. Ultrasound is the preferred imaging, and when the peak systolic velocity(PSV) of the uterine artery is greater than 60-70 cm/s, immediate intervention is required. Digital subtraction angiography(DSA) is the gold standard for diagnosing uterine arteriovenous fistula, which can be performed concurrently with uterine artery embolization to reduce bleeding. During surgery, intermural lesions should be carefully explored to prevent the formation of multiple arteriovenous fistulas between the muscles and the missed diagnosis. If uterine arteriovenous fistula is combined with retained products of conception, the combined hysteroscopy and laparoscopy may be the recommended treatment.

Key words: Uterine diseases, Arteriovenous fistula, Pregnancy residue, Diagnosis, Therapy, Case reports