BACKGROUND: Uterine artery pseudoaneurysm is a rare postoperative complication. Several case reports describe this occurring after cesarean deliveries, typically presenting as delayed postoperative bleeding.
CASE: A 26-year-old woman (gravida 1, para 0010) underwent a cervical cold-knife conization. She later presented three times over the subsequent 18 days with intermittent vaginal hemorrhage. After unsuccessful treatment with suture, prothrombotic agents, and ferric subsulfate, arteriography was performed with no abnormality identified. A bilateral iliac and uterine arteriography was repeated to facilitate prophylactic uterine artery embolization. A pseudoaneurysm of the right uterine artery was then visualized and embolized, resolving the symptoms.
CONCLUSION: Injury to the uterine artery causing pseudoaneurysm formation can cause persistent vaginal hemorrhage after cervical conization and may elude diagnosis by arteriography.