Intraperitoneal Bleeding Induced by a Ruptured Inferior Epigastric Artery Pseudoaneurysm following Interval Debulking Surgery for Ovarian Cancer: A Case Report.

Abstract

Introduction: Pseudoaneurysm following gynecologic cancer surgery is a rare complication that can become fatal when it ruptures. Common sites of pseudoaneurysms are the external iliac artery, hypogastric artery, and aorta, which are located around the lymphadenectomy site. There are no previous reports of ruptured inferior epigastric (IEA) artery pseudoaneurysms after gynecologic cancer surgery. We report a case of intraperitoneal bleeding induced by a ruptured IEA pseudoaneurysm following interval debulking surgery for stage IVB ovarian cancer.

Case presentation: The patient underwent total abdominal simple hysterectomy, bilateral salpingo-oophorectomy, omentectomy, ileocolic resection, and peritonectomy around the ileocecal area after 5 cycles of neoadjuvant chemotherapy. The patient suddenly presented with loss of consciousness and reduced blood pressure on postoperative day 20. Her blood hemoglobin levels also decreased. Contrast-enhanced computed tomography revealed a pseudoaneurysm in the right IEA. There were no signs of extravasation from the pseudoaneurysm; however, bloody ascites was observed in the abdominal cavity. A ruptured IEA pseudoaneurysm was suspected, and coil embolization was immediately performed. Her symptoms abated soon after coil embolization, and she remained symptom-free during the 8 months of postoperative follow-up.

Conclusion: Awareness of this rare complication is clinically important for its early detection and treatment.