Conservative treatment of bladder flap hematoma complicated with uterine artery pseudoaneurysm after cesarean section via internal iliac artery embolization: a case report.

Abstract

Background: Bladder flap hematoma (BFH) is a rare complication associated with cesarean section (CS). Its pathogenesis is linked to insufficient hemostasis and bleeding at the incision site, leading to the formation of a hematoma between the bladder and the lower uterine segment (LUS). To the best of the authors' knowledge, no specific protocols have been formulated to guide the treatment of BFH.

Case presentation: A 29-year-old woman underwent an emergency CS due to relative cephalopelvic disproportion. Twenty-two hours after the CS, she developed pale red hematuria accompanied with a significant decrease in hemoglobin. The patient experienced two fainting episodes after standing and engaging in activity, along with vaginal bleeding. A bedside ultrasound revealed a 50 mm fluid-filled sonolucent area between the lower uterine segment (LUS) and bladder. Subsequently, the patient received conservative treatment with internal iliac artery embolization, antibiotics and blood transfusion, to avoid secondary laparotomy. The angiography and computer tomography examinations revealed the existence of uterine artery pseudoaneurysm and a large BFH. Her vital signs remained stable after the intervention and repeat ultrasonography demonstrated a significant reduction in the hematoma size.

Conclusions: Selective pelvic artery embolization as a conservative treatment can be a safe and effective option for large BFH, provided the patient remains clinically stable. This interventional therapy presents an innovative, non-surgical approach to a condition that is typically treated surgically and may carry the risk of irreparable complications.