Massive retained products of conception with arteriovenous fistula successfully treated with arterial balloon occlusion and laparoscopic hysterectomy

OBJECTIVE: We report the case of retained products of conception (RPOC) with massive uterine arteriovenous fistula (AVF). CASE REPORT: A 42-year-old woman was referred to our hospital for having abnormal pregnancy at 9 weeks. Ultrasonography showed a deformed gestational sac. Serum hCG levels were initially markedly elevated but demonstrated a progressive decline over time. At 20 weeks gestation, a uterine mass grew with an abundant blood flow to replace the myometrium. The 3-dimensional blood vessel image constructed from the contrast enhanced CT showed a formation of massive AVF in the uterine mass. In consideration of the high risk of intraoperative hemorrhage, bilateral internal iliac artery balloon occlusion was strategically utilized as an adjunct, facilitating the execution of a minimally invasive total laparoscopic hysterectomy. CONCLUSION: It is important to evaluate the vessel image and select appropriate treatment considering the risk of bleeding.